Unforeseen events occur in the lives of individuals every day. When these affect our health and cause bodily harm or injury, we usually call them accidents. Cases of extreme urgency, constituting a threat to life or limb, we term emergencies.

Most hospitals are equipped with special facilities ranging from first aid stations to comprehensive trauma units. These emergency rooms are deluged with people having minor problems that have assumed the sense of urgency. However, many of these could well be taken care of at home.

Some of the more common health hazards and problems will be outlined in here. It is well to remember the Boy Scout motto “be prepared” in obtaining necessary knowledge before the crisis. A calm, cool head combined with a knowledge of what to do in an emergency may prove the difference between life and death as crises erupt in the home.

The words of Rudyard Kipling expressed it well, “If you can keep your head when all about you are losing theirs and blaming it on you... then you will be a man, my son.” These poetic expressions apply to every nurse, homemaker, and lifesaver who can render first aid in an emergency, and do the right thing, at the right time, in the right place, in the right way. Such individuals are at a premium in our turbulent society.

Cuts and Bruises

Bruising results when the skin or underlying tissue has been traumatized. A kick, a blow, or a fall may not break the skin, yet result in trauma to the underlying blood vessels. When one of these vessels, small or large, is injured, bleeding occurs beneath the skin. The black and blue discoloration that often results from such injuries are called a bruise (ecchymosis).

Applying ice packs immediately after such injury is helpful to reduce the bleeding, as well as relieve pain. Under NO circumstances should heat be applied to a bruise in the acute stage. Even in the healing phase, one should use heating measures with considerable caution.

Deep bruises in a muscle may produce swelling and considerable pain, but are located beneath the fascial planes and therefore show no visible discoloration. These also should be treated with ice. In the acute injury, some pressure is advisable to reduce the amount of bleeding. When the skin surface is broken, several other reactions take place.

First, there is a loss of blood, with the amount and rate of flow depending on the vessels that have been severed. Since the face and scalp are extremely rich in blood vessels, bleeding is often brisk. Yet because of its visible location, prompt pressure can reduce the blood loss.

A knowledge of appropriate pressure points, where arteries to the extremities come close to the surface, can prepare one to reduce blood flow in a very severe arterial injury. Pressure under the armpit, in the groin, or behind the knee may be life saving when a large artery has been ruptured. More commonly, however, the application of direct pressure over the wound will reduce the amount of blood flow.

With the normal clotting mechanism inherent in body tissues, the bleeding will then stop, allowing coagulation or clot formation to secure the area. The second problem that results when the skin is broken is that germs find entrance. Depending upon the amount of contamination, the wound may require thorough cleansing before any closure or bandaging is attempted.

Thorough irrigation with water is the most effective, provided that the water is clean. Done early after an acute injury this constitutes the most important aspect of care, since infection is easier to prevent than to treat. Contaminated wounds from the animal barn or farmyard should be exceptionally thoroughly washed.

Unless the person has been adequately immunized against tetanus, a booster is recommended. In cases where no immunity exists the administration of human tetanus antitoxin will provide an additional safeguard. These injections would, of course, need to be obtained from a physician or emergency room.

Once the bleeding is controlled and the cut thoroughly cleansed or irrigated, appropriate closure can be attempted. Sometimes we use a butterfly bandage or adhesive tape to bring the opposing edges together. Often that is all that is necessary to close the wound. Moreover, this simple closure, when free from infection, will produce the most rapid healing.

Sutures are necessary on occasion to close larger wounds, particularly those involving such delicate structures as the eyelid, lip, face, or hand. Deep wounds involving the hand must be carefully evaluated for possible injury to nerves or tendons. They should be repaired by a surgeon, whenever possible.

For the best results in both healing time and preventing complication, lacerations should be repaired within a very few hours after their occurrence, the sooner the better. Cuts left open for longer than 8-12 hours nearly always have been contaminated with so many germs that suturing or other tight closure will increase the risk of infection.

In such cases, open treatment and appropriate dressings are preferable. Before proceeding with a description of suturing techniques, note two other types of wounds and their simple treatments. Abrasions are injuries made by rubbing or scraping. Some of these, called “floor burns” or “scuff burns,” are very superficial injuries.

They usually bleed briskly, and often can be very painful. Careful cleansing of these wounds is important to remove all sand, dirt, glass, or other foreign material that may have been ground into the skin. Porous dressings are advisable to allow the air-skin contact to form a crust or scab.

Less commonly the extensive nature of an abrasion makes it advisable to apply an ointment, such as petroleum jelly with fine mesh gauze to prevent sticking. Puncture wounds may also occur. Although these do not usually bleed as extensively, the risk of infection is high.

A nail or tack may puncture or impale the skin. The most common place is the foot. Wear shoes or sandals and avoid playing in locations where rusty nails and broken glass abound. This will help to prevent most kinds of puncture injuries. Extreme care in the use of knives, scissors, power mowers, chain saws, razor blades, and firearms is likewise important to prevent penetrating wounds, particularly where small children live.

Sprains

In contrast to pulled muscles (strains), sprains involve the tearing or traumatic injury of ligaments. These are strong, fibrous structures surrounding the many joints. Common areas where sprains occur are the knees, ankles, and wrists, though almost any joint can be affected.

The typical “whiplash” injury of a rear-end automobile collision is also a ligamentous sprain. In reality, the entire spine is vulnerable to this type of injury. The general characteristics of a sprain are as follows: there is acute pain, localized in the involved joint.

Swelling follows, particularly if further ambulation or joint motion is continued, and the area is often held in a dependent position. When blood vessels are torn, bruising becomes apparent within hours, frequently turning the affected joint “black and blue.”

There are several important first aid measures to be used in suspected sprains. These include the immediate immobilization of the extremity, its elevation, and the application of ice packs. All of these remedies reduce the amount of swelling and pain.

They also help to control bleeding within the joint. Pain in any joint is a message from “nature” to rest the injured member. For sprained ankles, wrists, or knees, elastic bandages, crutches, and occasionally plaster casting is used for immobilization during the healing phase.

Hot and cold contrast treatments, used after the first 12 to 24 hours, aid in the resolution of these inflammatory changes. They also accelerate healing and reduce pain. Unusual persistence of pain in the involved area should alert one to the possibility of fracture, which is best diagnosed with an x-ray.