Common Household Injuries: Before Help Arrives, What Should You Do?

Unintentional injury in the home is the leading cause of death among children aged 14 and under. According to preventinjury.com, the leading preventable causes are: burns, choking, suffocation, drowning, falls, poisoning, and unintentional firearm injury. As summer returns, so do threats of swimming pools, falls from trampolines, grill burns and other common forms of outdoor play. Are you prepared to deal with an accident? Do you know how to handle and emergency, where seconds can mean permanent brain damage, disfigurement, or death? Below is a list of common situations and appropriate ways to handle them.

An accidental fall with a dislocation: A fall or powerful blow, such as can occur in contact sports, can result in bones being forced from their original place. They can occur in major areas, such as the hip, shoulder, knee, or elbow, and minor places such as fingers and toes. It is recommended to call for an ambulance immediately. Attempting to force the joint back into place can cause nerve and muscle damage. As the injury will stiffen and deform, before help arrives you may splint the joint into the fixed position, and apply ice to the joint (wrap the ice in something first to prevent frostbite). This will help control internal bleeding around the area.

A broken bone: If there is heavy bleeding, a limb looks deformed, gentle pressure causes pain, and/or there is a bluish color at the end of the injured limb, you probably have a fracture on your hands. First things first, call for medical attention. After help is on the way, try to stop any bleeding by applying pressure directly to the wound using a clean cloth, bandage, etc. At this point, don't try to reset the bone unless you have been trained to apply a splint. Remember that unlike a dislocation, a broken bone can pierce the skin if moved. Keep the injured still. As in the dislocation, apply ice to reduce swelling, but never directly to the body. Always wrap it in a towel or something similar. If after the break the injured begins feeling faint or breathing is fast and short, he/she is experiencing shock. In this case before help arrives, lay the person so that their head is lower than the middle trunk of the body and if possible, raise the legs.

Burns: Before you can properly treat a burn, you must decide the severity of the injury. A minor burn is the most common, and can be treated by cooling the burn under cool or cold water, and wrapping it in sterile gauze or a bandage. If pain is persistent, you may take an over-the-counter pain medication. Do not break blisters that occur, apply ointment, or ice to the injury. Ice actually can cause frostbite and ointments can affect the way a burn heals. In other burn cases, you will need to recognize and treat a more major burn correctly.

First-degree burns are the least serious and involve redness, swelling and pain, however the outer layer of skin hasn't been burned the way through. These burns are generally treated as minor unless the area affected is a major joint (hip, shoulder), or is extensive coving a large portion of the body.

Second-degree burns are more severe, when more than the outer layer of skin is burned. The skin will blister and turn very red; also the pain will be more intense. It is recommended that if the second-degree burn is 3in or less, you may treat it as a minor burn. However if it is larger or if the burn is on the groin area, hand, feet, backside, or a over major joint it should be treated as a major burn and help should be called immediately.

Third-degree burns are very serious, affecting all layers of skin including fat, muscle, and sometimes bone. These burns will be painless and result in permanent tissue damage. The skin may look charred, black, or white and dry. First of all, call for medical help right away. While making sure that the injured isn't in contact with any fire or smolders, don't remove burnt clothes. Also, unlike less major burns, do not immerse the injury cool or cold water, as shock may occur. Instead apply cool, clean and sterile moist towels or cloth. Raise and elevate burned parts of the body above the level of the heart, and if shock is present, follow the steps as with a broken bone. Also, if you are trained in CPR, look for signs of breathing or a pulse. If there is none, begin resuscitation.

Choking: If a person cannot talk, is breathing loudly, hands are around their throat, or lips, nails, and skin are turning blue, you must take steps to dislodge the object choking the victim fast. As oxygen is cut off from the brain, permanent damage occurs, even in a few minutes. The Red Cross recommends a "five and five" method. First, deliver five blows to the person with heel of your hand to the area of the back between the shoulder blades five times. After that, perform five abdominal thrusts, or the Heimlich Maneuver. If you are alone with the choking person, do the "five and five" technique before calling for medical aid. If not, have another person call for help while you administer the aid. Continue five blows to five Heimlich Maneuvers until help arrives. If you need to clear the airway on an unconscious person, lie them down on their back. Look inside the mouth for visible blockage and use a finger to sweep it away. Be very careful not to lodge the object deeper into the airway.

To perform the Heimlich Manuver for someone else: Stand behind them with your arms around their waist. Tip them forward slightly. Make a fist with one hand and place it a little above the person's belly button. Wrap your other hand around the fist and begin quick, upward thrusts, as if you were trying to lift the person up. If the person is either pregnant or obese, place your hand and fist slightly higher, there the breastbone ends and above the joining of the lowest ribs.

Poisoning: Before administering any aid, make sure it is a real poisoning and not a seizure, stroke, insulin reaction, etc. Look for redness or burns which can happen from drinking poisons around mouth and lips. Breath that smells of a chemical, like bleach or gasoline. Look for burns on the injured, their clothing, or the area where they were such as floor or furniture. Keep an eye out for any medication bottles or loose pills, and if there is vomiting, confusion, or other strange symptoms. Make sure to call for help right away, especially if the person has stopped or difficulty breathing, is agitated or restless, having seizures, or other activity such as this. While waiting for help, it is important to try to find what was swallowed. Remove any still in the mouth, such as pills, and if it was a household chemical, immediately look on the bottle for poison control information. It will tell you to call the poison control center at 800-222-1222, and will ask about the chemical swallowed. NEVER induce vomiting or give a victim ipecac syrup. Follow the directions given by the poison control center. Remove any clothing with spilled chemical and flush the affected area with lukewarm or cool water for 20 minutes before help arrives. Also, bring the bottle which was drunk or swallowed with you to the hospital.

Drowning: Pool drowning is extremely common in the US, and occurs with or without supervision. It is the responsibility of all supervisors to look for signs of drowning and act accordingly. Remove the child from the water and lay them on their back. If you are not alone with the victim, have someone call for help immediately. You will need to clear the airway first by tilting the head back (place your hand across the forehead as if checking for fever), and lift the jaw (using the tips of the fingers of your other hand, right under the chin raising it up). Now you need to check for breathing. Look for the chest rising up and down or feel/listen for breaths. If no there is no breathing, you must administer rescue breathing. Pinch the nose closed and cover the child's open mouth with your own (if the child is under 1 year of age, cover the both nose and mouth with your own). Gently administer two breaths of air; you should see the chest rise and fall with the breaths. If it doesn't rise, you haven't created a tight seal with your mouth or by pinching the nose closed. Just be calm and try again. Be aware that administering air this way can result in stomach distension, or vomiting if air travels into the stomach. Be gentle. At this point, you also need to check the child's circulation. If you feel a pulse, continue the rescue breaths every 3 seconds, removing your mouth after each so the child can exhale. If there is no pulse, you will need to give CPR, until help arrives. Please be aware that there have been recent changes in CPR beginning in 2005, and are different for infants, children, and adults. If you haven't updated your CPR technique, I urge you to take a refresher course.

Suffocation: As in choking and drowning, the ABC's of first aid need to be followed, that is "airway, breathing, and circulation." Check and clear the airway, check breathing, etc. In suffocation in children, prevention is most important. Young children under 3 are especially are vulnerable to suffocation as they are inexperienced with chewing and put everything into their mouths. Brain death and permanent damage occurs within 4 minutes of oxygen deprivation. A baby can suffocate on hot dogs, grapes, chunks of almost any food, candies, and even popcorn. Strings from pull shades and drapery, clothing drawstrings, pacifier cords can become entangled around the neck of a curious child, and cribs are associated with 40% of strangulation and suffocation deaths each year. Children may suffocate from accidently trapping their heads between spaces in high chairs, strollers, and play equipment. It is up to parents and supervisors to identify and remove hazardous items around the house. Please review this paper for possible dangerous household items: http://www1.dshs.wa.gov/pdf/ca/choking.pdf.

Unintentional firearm injury: About one-third of American households with children also have a firearm. Although less common than burns or drowning, children and guns are frequently devastating mixtures, resulting in major injury and death. Firearms are recommended to be kept locked and unloaded, with ammunition locked away in a separate location. It is also suggested asking the friend's of your children if they have firearms, and if so how they are stored. The issue of firearms in the home is a controversial one, I invite you to review this article on the subject and act in a responsible manner that you decide: http://www.med.umich.edu/1libr/yourchild/guns.htm.

Most of us don't want to imagine the possibility of a child or loved one being seriously injured or worse, especially in an assumed safe place such as the home. However, the best recommendation this writer can suggest to everyone out there is to learn CPR and basic first aid. I have, it is a simple and inexpensive class (sometimes free), and will not only empower you to act calmly and decisively in an emergency situation; it can also save the life of someone you love. Unexpected events can happen at any time, any place, especially with children. Being prepared and educated can mean the difference between a happy, healthy child or adult, permanent damage and injury, or even death.

References and sites of interest:

http://preventinjury.com/

http://www.mayoclinic.com/health/FirstAidIndex/FirstAidIndex

http://www.indiaparenting.com/articles/data/art10_006.shtml

http://www.americanheart.org/presenter.jhtml?identifier=3011764

http://www1.dshs.wa.gov/pdf/ca/choking.pdf

http://www.med.umich.edu/1libr/yourchild/guns.htm