Emergencies

Introduction
Cardiopulmonary Resuscitation
Heat Exhaustion And Heatstroke
Cuts, Scrapes and Stitches
Lead Poisoning in Children
Cat and Dog Bites
Nosebleeds

If you, or someone you know, is ever sick or injured and needs emergency help, remember-there are lots of people who are specially trained to help you get better!

CPR may be done when a person stops breathing or the heart stops beating (like when a person has a heart attack). When it's possible that the person may get better, CPR is important.

However, when a patient has an advanced life-threatening illness (such as cancer) and is dying, CPR may not be the option to choose. It's important for the patient, family members and doctor to talk about this issue before the need arises.

What happens during CPR?

During CPR, the chest is pressed on forcefully. Electric stimulation to the chest and special medicines are sometimes used. This is usually done for 15 to 30 minutes. A tube may also be put through the mouth or nose into the lung. This tube is then connected to a breathing machine.

What happens if CPR isn't done?

A person will become unconscious almost immediately and will die in 5 to 10 minutes.

What are the benefits of CPR?

For a patient with an advanced life-threatening illness who is dying, there are really no benefits.

CPR may prolong life for patients with a better health status or who are younger. CPR may also prolong life if it's done within 5 to 10 minutes of when the person's heart stopped beating or breathing stopped.

What are the risks of CPR?

Pressing on the chest can cause a sore chest, broken ribs or a collapsed lung. Patients with breathing tubes usually need medicine to keep them comfortable. Most patients who survive will need to be on a breathing machine in the intensive care unit to help them breathe for a while.

Few patients (less than 10 percent) in the hospital who have had CPR survive and are able to function the way they used to. Many patients live for a short time after CPR, but still die in the hospital. CPR may also prolong the dying process.

Patients who have more than one illness usually don't survive after CPR. Almost no one with advanced cancer survives CPR and lives long enough to leave the hospital. Of the few patients who do, many get weaker or have brain damage. Some patients may need to live on a breathing machine for the rest of their lives.

Heat-related illnesses, such as heat exhaustion and heatstroke, occur when your body can't keep itself cool. As the air temperature rises, your body stays cool when your sweat evaporates. On hot, humid days, the evaporation of sweat is slowed by the increased moisture in the air. When sweating isn't enough to cool your body, your body temperature rises, and you may become ill.

What is heat exhaustion?

Heat exhaustion happens when your body gets too hot. It can be caused by exercise or hot weather. You may feel weak, dizzy or worried. You also may have a headache or a fast heartbeat. You may get dehydrated and have very little urine.

What should I do if I think I have heat exhaustion?

If you think you have heat exhaustion, get out of the heat quickly. Rest in a cool, shady place. Drink plenty of water or other fluids. Do NOT drink alcohol. Alcohol can make heat exhaustion worse. If you do not feel better within 30 minutes, you should contact your doctor. If heat exhaustion is not treated, it can progress to heatstroke.

What is heatstroke?

Heatstroke can happen when your body gets too hot, or it can happen after heat exhaustion. Heatstroke is much more serious than heat exhaustion. Heatstroke can kill you. People with heatstroke may seem confused. They may have seizures or go into a coma. Most people with heatstroke also have a fever.

What should I do if I think someone has heatstroke?

If you think someone might have heatstroke, you should take him or her to a cool, shady place quickly, and call a doctor. Removing the person's unnecessary clothing can help cool him or her down. Try to fan warm air over the person while wetting the skin with lukewarm water. This will help the person cool down.

What does the "heat index" mean?

The heat index tells you how hot it feels outside in the shade. It is not the same as the outside temperature. The heat index is a measurement of how hot it feels when relative humidity is combined with the effects of the air temperature. When you are standing in full sunshine, the heat index value is even higher. A heat index of 90° or above is dangerous.

How can I prevent heat illness?

When the heat index is high, stay indoors in air-conditioned areas when possible. If you must go outside, take the following precautions:

• Wear lightweight, light-colored, loose-fitting clothes.
• Protect yourself from the sun by wearing a hat or using an umbrella.
• Use sunscreen with a sun protection factor (SPF) of 15 or more.
• Drink plenty of water before starting an outdoor activity. Drink extra water all day. Drink fewer beverages that contain caffeine (such as tea, coffee and cola) or alcohol.
• Schedule vigorous outdoor activities for cooler times of the day--before 10 a.m. and after 6 p.m.
• During an outdoor activity, take frequent breaks. Drink water or other fluids every 15 to 20 minutes, even if you don't feel thirsty.
• If you have clear, pale urine, you are probably drinking enough fluids.
• If you have a chronic medical problem, ask your doctor about how to deal with the heat, about drinking extra fluids and about your medicines.

What should I do after having heat exhaustion or heatstroke?

Having heat exhaustion or heatstroke makes you more sensitive to hot conditions for about a week afterwards. Be especially careful not to exercise too hard, and avoid hot weather. Ask your doctor to tell you when it is safe to return to your normal activities.

The best way to clean a cut, scrape or puncture wound (such as from a nail) is with cool water. You can hold the wound under running water or fill a tub with cool water and pour it from a cup over the wound.

Use soap and a soft washcloth to clean the skin around the wound. Try to keep soap out of the wound itself because soap can cause irritation. Use tweezers that have been cleaned in isopropyl alcohol to remove any dirt that remains in the wound after washing.

Even though it may seem that you should use a stronger cleansing solution (such as hydrogen peroxide or an antiseptic), these things may irritate wounds. Ask your family doctor if you feel you must use something other than water.

What about bleeding?

Bleeding helps clean out wounds. Most small cuts or scrapes will stop bleeding in a short time. Wounds on the face, head or mouth will sometimes bleed a lot because these areas are rich in blood vessels.

To stop the bleeding, apply firm but gentle pressure on the cut with a clean cloth, tissue or piece of gauze. If the blood soaks through the gauze or cloth you're holding over the cut, don't take it off. Just put more gauze or another cloth on top of what you already have in place and apply more pressure.

If your wound is on an arm or leg, raising it above your heart will also help slow the bleeding.

Should I use a bandage?

Leaving a wound uncovered helps it stay dry and helps it heal. If the wound isn't in an area that will get dirty or be rubbed by clothing, you don't have to cover it.

If it's in an area that will get dirty (such as your hand) or be irritated by clothing (such as your knee), cover it with an adhesive strip (Band-Aid) or with sterile gauze and adhesive tape. Change the bandage each day to keep the wound clean and dry.

Certain wounds, such as scrapes that cover a large area of the body, should be kept moist and clean to help reduce scarring and speed healing. Bandages used for this purpose are called occlusive or semiocclusive bandages. You can buy them in drug stores without a prescription. Your family doctor will tell you if he or she thinks this type of bandage is best for you.

Should I use an antibiotic ointment?

Antibiotic ointments (such as Bacitracin) help healing by keeping out infection and by keeping the wound clean and moist. A bandage does pretty much the same thing. If you have stitches, your doctor will tell you whether he or she wants you to use an antibiotic ointment. Most minor cuts and scrapes will heal just fine without antibiotic ointment, but it can speed healing and help reduce scarring.

What should I do about scabs?

Nothing. Scabs are the body's way of bandaging itself. They form to protect wounds from dirt. It's best to leave them alone and not pick at them. They will fall off by themselves when the time is right.

When should I call my doctor?

Call your doctor if your wound is deep, if you can't get the edges to stay together or if the edges are jagged. Your doctor may want to close your wound with stitches or skin adhesive. These things can help reduce the amount of scarring.

You can close small cuts yourself with special tape, called butterfly tape, or special adhesive strips, such as Steri-Strips.

How do I take care of stitches?

You can usually wash an area that has been stitched in one to three days. Washing off dirt and the crust that may form around the stitches helps reduce scarring. If the wound drains clear yellow fluid, you may need to cover it.

Your doctor may suggest that you rinse the wound with water and rebandage it in 24 hours. Be sure to dry it well after washing. You may want to keep the wound elevated above your heart for the first day or two to help lessen swelling, reduce pain and speed healing.

Your doctor may also suggest using a small amount of antibiotic ointment to prevent infection. The ointment also keeps a heavy scab from forming and may reduce the size of a scar.

Stitches are usually removed in 3 to 14 days, depending on where the cut is located. Areas that move, such as over or around the joints, require more time to heal.

What is skin adhesive?

Skin adhesive (such as Dermabond) is a new way to close small wounds. Your doctor will apply a liquid film to your wound and let it dry. The film holds the edges of your wound together. You can leave the film on your skin until it falls off (usually in 5 to 10 days).

It's important not to scratch or pick at the adhesive on your wound. If your doctor puts a bandage over the adhesive, you should be careful to keep the bandage dry. Your doctor will probably ask you to change the bandage every day.

Don't put any ointment, including antibiotic ointment, on your wound when the skin adhesive is in place. This could cause the adhesive to loosen and fall off too soon. You should also keep your wound out of direct light (such as sunlight or tanning booth lamps).

Keep an eye on your wound. If the skin around your wound becomes very red and warm to touch, or if the wound reopens, call your doctor.

Do I need a tetanus shot?

Tetanus is a serious infection you can get after a wound. The infection is also called "lockjaw," because stiffness of the jaw is the most frequent symptom.

To prevent tetanus infection when the wound is clean and minor, you'll need a tetanus shot if you haven't had at least three doses before or haven't had a dose in the last 10 years.

When the wound is more serious, you'll need a tetanus shot if you haven't had at least 3 doses before or if you haven't had a shot in the last 5 years. The best way to avoid tetanus infection is to talk to your family doctor to make sure your shots are up to date.

High levels of lead in the body can cause problems with the brain, kidneys and bone marrow (the soft tissue inside bones). Symptoms of high lead levels can include belly pain, headaches, vomiting, confusion, muscle weakness, seizures, hair loss and anemia (a low red blood cell count).

Lower levels of lead in the body can also cause problems, like trouble paying attention, behavior problems, learning difficulties and a fall in the IQ of young children. (IQ stands for "intelligence quotient" and is one measure of how smart a person is.)

In what ways are children exposed to lead?

Lead is a heavy metal that is found naturally in the Earth's crust. It has historically been used in a number of household products.

More than 4% of children in the United States have lead poisoning. Rates of lead poisoning are higher in large cities and among people with low incomes.

The most common cause of lead poisoning today is old paint with lead in it. Lead has not been used in house paint since 1978. However, many older houses and apartment buildings (especially those built before 1960) have lead-based paint on their walls.

Toddlers explore their world by putting things in their mouths. Therefore, young children who live in older buildings are at especially high risk of getting lead poisoning. Children can get lead poisoning by chewing on pieces of peeling paint or by swallowing house dust or soil that contains tiny chips of the leaded paint from these buildings.

Lead can also be in air, water and food. Lead levels in the air have gone down greatly since lead was taken out of gasoline in the 1970s. Lead is still found in some old water pipes, although using lead solder to mend or put together water pipes is no longer allowed in the United States. Lead can also be found in food or juice stored in foreign-made cans or improperly fired ceramic containers.

How can I lower the risk that my child will get lead poisoning?

• If you live in a house or an apartment built before 1978, ask your doctor about blood lead testing for your child and keep your child away from peeling paint. Peeling paint needs to be removed from all surfaces up to 5 feet above the floor. It is also a good idea to repaint the rooms to seal in the lead paint.
• If you're remodeling an old home, seal off the rooms that are being worked on. For example, put heavy sheets of plastic over doorways and windows of the work area.
• If there's a problem with lead poisoning in the area where you live, or if a lot of older houses in your neighborhood are being remodeled, have your family wipe their feet and take their shoes off before they come into your home. This will lower the chance of tracking soil with lead in it into your home.
• Wash your child's hands and face before meals.

To get more information about what else you can do to lower your family's exposure to lead, talk to your doctor or call your local health department (the number is in the phone book). Tell your doctor if you are concerned that your child may have been exposed to lead.

What will my doctor do if my child's blood has a high level of lead?

During regular well-child checkups for your baby, toddler or preschooler, your doctor will ask you questions to see if there is a chance that your child might get lead poisoning. The doctor might test your child's blood for lead.

If your child's blood lead level is above normal, your doctor will give you information on how you can lower your child's lead level. Your doctor will then test your child's blood lead level every few months until the level drops into the normal range.

Fortunately, only a small number of babies and children have high enough levels of lead in their blood that they need treatment. If your child's blood lead level is very high, your doctor will treat your child with medicine to lower the amount of lead in the blood.

If one or more of your children has high blood lead levels, your doctor will call your local health department. Persons from the health department can help by inspecting your home for old peeling paint and getting workers to remove the paint or cover it with new paint.

Here are some things you should do to take care of a wound caused by a cat or dog bite:

• If necessary, call your doctor.
• Wash the wound gently with soap and water.
• Apply pressure with a clean towel to the injured part to stop the bleeding.
• Apply a sterile bandage to the wound.
• Keep the injury elevated above the level of the heart to slow swelling and prevent infection.
• Report the incident to the proper authority in your community (for example, animal control office or police).
• Apply antibiotic ointment to the area 2 times every day until it heals.

What will my doctor do?

Here are some things your doctor may do to treat a cat or dog bite:

• Examine the wound for possible nerve or tendon damage, or bone injury. He or she will also check for signs of infection.
• Clean the wound with a special solution and remove any damaged tissue.
• May use stitches to close a bite wound, but often the wound is left open to heal, so the risk of infection is lowered.
• May prescribe an antibiotic to prevent infection.
• May give you a tetanus shot if you had your last shot more than 5 years ago.
• May ask you to schedule an office visit to check your wound again in 1 to 2 days.
• If your injury is severe, or if the infection has not gotten better even though you're taking antibiotics, your doctor may suggest that you see a specialist and/or go to the hospital, where you can get special medicine given directly in your veins (intravenous antibiotics) and further treatment if necessary.

Will I need a rabies shot?

Probably not. Rabies is uncommon in dogs and cats in the United States. If a dog or cat that bit you appeared to be healthy at the time of the bite, it's unlikely that the animal had rabies. However, it's a good idea to take some precautions if you're bitten by a dog or cat.

If you know the owner of the dog or cat that bit you, ask for the pet's vaccination record (record of shots). An animal that appears healthy and has been vaccinated should still be quarantined (kept away from people and other animals) for 10 days to make sure it doesn't start showing signs of rabies. If the animal gets sick during the 10-day period, a veterinarian will test it for rabies. If the animal does have rabies, you will need to get a series of rabies shots.

If the animal is a stray, or you can't find the owner of the dog or cat that bit you, call the animal control agency or health department in your area. They will try to find the animal so it can be tested for rabies.

If the animal control agency or health department can't find the animal that bit you, if the animal shows signs of rabies after the bite, or if a test shows that the animal has rabies, your doctor will probably want you to get a series of rabies shots (also called postexposure prophylaxis). You need to get the first shot as soon as possible after the bite occurs. After you receive the first shot, your doctor will give you 5 more shots over a 28-day period.

How can I prevent cat and dog bites?

Here are some things you can do to prevent bites:

• Never leave a young child alone with a pet.
• Do not try to separate fighting animals.
• Avoid sick animals and animals that you don't know.
• Leave animals alone while they're eating.
• Keep pets on a leash when in public.
• Select your family pet carefully, and be sure to keep your pet's vaccinations (shots) up-to-date.

A nosebleed can be scary to get--or see--but try to stay calm. Most nosebleeds look much worse than they really are. Almost all nosebleeds can be treated at home.

What should I do when I get a nosebleed?

If you get a nosebleed, sit down and lean slightly forward. Keeping your head above your heart will make your nose bleed less. Lean forward so the blood will drain out of your nose instead of down the back of your throat. If you lean back, you may swallow the blood. This can cause nausea, vomiting and diarrhea.

Use your thumb and index finger to squeeze together the soft portion of your nose. This area is located between the end of your nose and the hard, bony ridge that forms the bridge of your nose. Keep holding your nose until the bleeding stops. Don't let go for at least 5 minutes. If it's still bleeding, hold it again for 10 minutes straight.

You can also place a cold compress or an ice pack across the bridge of your nose. Once the bleeding stops, don't do anything that may make it start again, such as bending over or blowing your nose.

What causes nosebleeds?

The most common causes are dryness (often caused by indoor heat in the winter) and nose picking. These two things work together--nose picking occurs more often when mucus in the nose is dry and crusty.

Other, less common, causes include injuries, colds, allergies or cocaine use. Children may stick small objects up the nose. Older people may have atherosclerosis ("hardening of the arteries"), infections, high blood pressure and blood clotting disorders, or they may be taking drugs like aspirin that interfere with blood clotting. The cause of nosebleeds often can't be determined.

Why is the nose prone to bleeding?

The nose has many blood vessels in it to help warm and humidify the air you breathe. These vessels lie close to the surface, making them easy to injure.

Are nosebleeds serious?

Most aren't. Most nosebleeds occur in the front part of the nose and stop in a few minutes.

A few nosebleeds stem from large vessels in the back of the nose. These nosebleeds can be dangerous. They may occur after an injury. This type of nosebleed is more common in the elderly and is often due to high blood pressure, atherosclerosis, daily aspirin use or bleeding disorders. Usually, the older the patient, the more serious the nosebleed.

You'll need to get medical attention if a nosebleed goes on for more than 15 minutes or if it occurs after an injury, such as a punch in the face, especially if you think you may have a broken nose. A nosebleed after a fall or car wreck could be a sign of internal bleeding.

Frequent nosebleeds may mean you have a more serious problem. For example, nosebleeds and bruising can be early signs of leukemia. Nosebleeds can also be a sign of blood clotting disorders and nasal tumors (cancerous and non-cancerous).

What will my doctor do for a nosebleed?

Your doctor will try to find out where the bleeding is coming from in your nose. He or she will probably ask you some questions and examine your nose. If the bleeding doesn't stop on its own or with pressure applied, your doctor may cauterize the bleeding vessel or pack your nose to stop the bleeding.

Cauterization involves using special solutions or an electrical or heating device to burn the vessel so that it stops bleeding. Your doctor will numb your nose before the procedure.

Packing the nose involves putting special gauze or an inflatable latex balloon into the nose so that enough pressure is placed on the vessel to make it stop bleeding.