• In the Eye

If you get a foreign object in your eye:

1. Try to flush the eye clear. Using an eyecup or small, clean glass, wash your eye with clean water. Position the glass with its rim resting on the bone at the base of your eye socket and pour the water in, keeping your eye open.
2. If you can't clear your eye, seek emergency medical assistance.

To help someone else who has a foreign object in the eye:

1. Wash your hands. Don't rub the eye. Seat the person in a well-lit area.
2. Try to locate the object in the eye visually. Examine the eye by gently pulling the lower lid downward and instructing the person to look upward. Reverse the procedure for the upper lid. Hold the upper lid and examine the eye while the person looks downward. If you find that the foreign object is embedded in the eyeball, cover the person's eye with a sterile pad or a clean cloth. Do not try to remove the object.
3. If the object is large and makes closing the eye difficult, cover the eye and the object with a paper cup. Do not remove the object. Seek emergency medical assistance.
4. If the object is floating in the tear film or on the surface of the eye, you may be able to flush it out or remove it manually. While holding the upper or lower lid open, use a moistened cotton swab or the corner of a clean cloth to remove the object by lightly touching it. If you can't remove the object easily, cover both eyes with a soft cloth and seek emergency medical assistance.
5. If you do remove the object, flush the eye with a saline solution or lukewarm water.
6. If pain, vision problems or redness persists, seek emergency medical assistance.

Broken Bone

After injury or trauma, dial 911 or call for emergency medical assistance if:

• The person is unresponsive, isn't breathing and isn't moving. Begin cardiopulmonary resuscitation (CPR).
• There is heavy bleeding.
• Even gentle pressure or movement causes pain.
• The limb or joint appears deformed or the bone has pierced the skin.
• The part of the injured arm or leg farthest from the heart, such as a toe or finger, is numb or bluish at the tip.

Take these precautions immediately while waiting for medical help:

1. Stop the bleeding. If there is bleeding, press directly on the wound with a sterile bandage, a clean cloth or a piece of clothing. Try to elevate the injured area above the heart to reduce bleeding and swelling. Apply pressure until the bleeding stops.
2. Immobilize the area. Keep the joints above and below the fracture immobilized, but don't try to set the bone. A splint stabilizes the damaged parts and prevents unwanted movement, which could aggravate tissue damage. Proper splinting may reduce pain. The less movement of the affected area, the better.
   
   To design a splint, use a rigid material such as wood, plastic or metal. The splint should be longer than the bone it is splinting and extend below and above the injury. Pad the splint with gauze wherever possible. Pads make the splint more comfortable and help keep the bones straight.
   
   Fasten the splint to the limb with gauze or strips of cloth or string. Start wrapping from the extremity and work toward the body. Splint the limb firmly to prevent motion but not tight enough to stop blood flow.
   
   To splint the lower portion of an arm (forearm): Tie rolled magazines or newspapers around the forearm. Wrap a sling over the shoulder and a band around the sling to help keep the elbow still.
   
   To splint the lower portion of a leg (shinbone): Place the entire leg between two splints. If no splints are available, use the healthy leg as a splint to impede movement of the broken one. If the thighbone is broken, immobilize the hip joint by gently moving the person onto a rigid surface such as a tabletop or door.
3. Apply cold. If ice is available, wrap the ice in cloth and apply it to the splinted limb.
4. Treat for shock. If the person becomes faint or is breathing in short breaths, he or she may be in shock. Lay the person down with the head slightly lower than the trunk and elevate the legs.

Frostbite

When exposed to very cold temperatures, skin and underlying tissues may freeze, resulting in frostbite. The areas most likely to be affected are your hands, feet, nose and ears.

You can identify frostbite by the hard, pale and cold quality of the skin that has been exposed to the cold. As the area thaws, the flesh becomes red and painful.

If your fingers, ears or other areas are frostbitten:

1. Get out of the cold.
2. Warm your hands by tucking them into your armpits. If your nose, ears or face is frostbitten, warm the area by covering it with dry, gloved hands.
3. Don't rub the affected area, especially with snow.
4. Get emergency medical help if numbness remains during warming. If you can't get help immediately, warm severely frostbitten hands or feet in warm not hot water. The water temperature should be between 100 F and 105 F.

• Head Trauma

Most head injuries are minor and don't require hospitalization. However, dial 911 or call for emergency medical assistance if any of the following symptoms are apparent:

• Severe head or facial bleeding
• Change in level of consciousness, even if temporary
• Black-and-blue marks below the eyes or behind the ears
• Cessation of breathing

If a severe head injury occurs:

1. Keep the person who sustained the injury lying down and quiet in a darkened room, with the head and shoulders slightly elevated. Avoid moving the person's neck.
2. Stop any bleeding with gauze or a clean cloth.
3. Observe the person for 1 to 2 hours to be sure the level of consciousness doesn't change.
4. If the person stops breathing, do mouth-to-mouth rescue breathing.

Heart Attack

A heart attack occurs when the arteries supplying your heart with blood and oxygen become blocked. This loss of blood is what injures your heart muscle. A heart attack generally causes chest pain for more than 15 minutes, but it can also be silent and have no symptoms at all.

About half of heart attack victims have warning symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain that's triggered by exertion and relieved by rest.

The American Heart Association lists these warning signs of a heart attack. Be aware that you may not have all of them, and that symptoms may come and go.

• Uncomfortable pressure, fullness or squeezing pain in the center of your chest, lasting more than a few minutes
• Pain spreading to your shoulders, neck or arms
• Light-headedness, fainting, sweating, nausea or shortness of breath

If you suspect a heart attack or even indigestion, act immediately:

1. Call 911. The operator contacts the emergency medical services (EMS) system. In areas without 911 service, call the emergency medical response system. It's usually better to call these emergency numbers first. Calling your doctor may add unnecessary time. When you call, describe symptoms such as severe shortness of breath or chest pain. This ensures a priority dispatch of EMS responders (paramedics) trained in basic and advanced cardiac life support. Most EMS units carry portable defibrillators. Restoring normal heart rhythm by delivering electrical shocks to the heart is critical to early treatment and survival. Many police and fire rescue units also carry defibrillators and may respond before an ambulance does.
2. Begin CPR. If the person you are calling about is unconscious, an emergency dispatcher may advise you to begin mouth-to-mouth rescue breathing and chest compression (cardiopulmonary resuscitation, or CPR). Even if you're not trained, a dispatcher can instruct you in CPR until help arrives.
3. Decide on the fastest method of transportation. A dispatcher automatically notifies the closest well-equipped EMS unit. Ideally, EMS responders should reach you within 4 to 5 minutes. If you live in a rural or large metropolitan area, however, you may get someone to the hospital faster by driving him or her yourself. If you think you're having a heart attack, ask someone to drive you. Never drive yourself.
4. Go to the nearest emergency cardiac care facility. Identify in advance the nearest center staffed 24 hours a day with physicians trained to provide emergency cardiac care.
5. Chew aspirin. Aspirin inhibits blood clotting, which helps maintain blood flow through a narrowed artery. When taken during a heart attack, aspirin can decrease death rates by about 25 percent. If you think you are having a heart attack, take one regular-strength aspirin and chew it to speed absorption.

Heat Cramps

Heat cramps are painful, involuntary muscle spasms usually occurring during heavy exercise in hot environments. Inadequate fluid intake often contributes to this problem. The spasms may be more intense and more prolonged than typical nocturnal leg cramps. Muscles most often affected include the calves, arms, abdomen and back, although the cramps may involve any muscle group involved in the exercise at hand.

If you suspect heat cramps:

Rest briefly; cool down.

Drink water or an electrolyte-containing sports drink.

Practice gentle, range-of-motion stretching and gentle massage of the affected muscle group.

Don't take salt tablets.

Heat Exhaustion

Heat exhaustion is one of the heat-related syndromes, which range in severity from mild heat cramps to heat exhaustion to potentially life-threatening heat stroke.

Signs and symptoms of heat exhaustion often begin suddenly, sometimes after excessive exercise, perspiration and inadequate fluid intake. Features resemble shock and include:

• Faintness
• Nausea
• Ashen appearance
• Rapid heartbeat
• Low blood pressure
• Hot, red, dry or sweaty skin
• Low grade fever, generally less than 104 F

If you suspect heat exhaustion:

1. Get the person out of the sun and into a shady or air-conditioned location.
2. Lay the person down and elevate the feet slightly.
3. Loosen or remove the individual's clothing.
4. Have the person drink cold water, not iced, or an electrolyte-containing sports drink.
5. Cool the person by spraying him or her with cool water and fanning.
6. Monitor the person carefully. Heat exhaustion can quickly become heatstroke. If fever especially one greater than 104 F fainting, confusion or seizures occur despite treatment, dial 911 or call for emergency medical assistance.

Heatstroke

Similar to heat cramps and heat exhaustion, heatstroke is one of the heat-related syndromes often resulting from heavy work in hot environments, usually accompanied by inadequate fluid intake. Older adults, people who are obese and people born with an impaired ability to sweat are at high risk of heatstroke. Other risk factors include dehydration, alcohol use, cardiovascular disease and certain medications.

What makes this syndrome much more severe and potentially life threatening is the fact that the body's normal mechanisms for dealing with heat stress, such as sweating and temperature control, are lost. The main indication of heatstroke is a markedly elevated temperature generally greater than 104 F with hot, dry skin and changes in mental status ranging from personality changes to confusion and coma.

Other signs may include:

• Rapid heartbeat
• Rapid and shallow breathing
• Increased or lowered blood pressure
• Cessation of sweating
• Irritability, confusion or unconsciousness
• Fainting, which can be the first sign in older adults

If you suspect heatstroke:

1. Move the person out of the sun and into a shady or air-conditioned space.
2. Dial 911 or call for emergency medical assistance.
3. Cool the person by covering him or her with damp sheets or by spraying with cool water. Direct air onto the person with a fan or newspaper.
4.  

Mouth-to-Mouth Rescue Breathing

If a person seems to have stopped breathing, dial 911 or call for emergency medical assistance. Then begin mouth-to-mouth rescue breathing.

To perform mouth-to-mouth rescue breathing:

1. Position the person so you can check for breathing. Lay the person flat on a firm surface and gently tip the head back. Place yourself next to the person's neck and shoulders.
2. Open the person's mouth and airway by lifting the chin forward.
3. Determine whether the person is breathing by listening for the sounds of breathing, feeling for air motion on your cheek and ear, and looking for chest motion.
4. If the person is not breathing, pinch the person's nostrils closed, make a seal around the mouth and breathe into his or her mouth twice. Following this initial breath, give one breath every 5 seconds (12 breaths each minute). Completely refill your lungs after each breath.

Continue to breathe for the person until the person can breathe on his or her own or until emergency medical help arrives.

Stroke

A stroke occurs when the blood supply to your brain is altered and brain tissue is starved of blood. Within 4 minutes of being deprived of essential nutrients, brain cells begin to die.

This is a true emergency. Seek immediate medical assistance. The faster treatment is given, the more likely damage can be minimized. Every moment counts. Remember: The longer a stroke goes untreated, the greater the damage and potential disability. Success of treatment may depend on how soon you receive care. Risk factors for stroke include being older, having high blood pressure, having had a previous stroke, smoking, having diabetes and having had heart disease.

If you notice one or more of the signs or symptoms listed below, call your doctor immediately. They may be signaling a possible stroke or transient ischemic attack (TIA).

• Sudden weakness or numbness in your face, arm or leg on one side of your body
• Sudden dimness, blurring or loss of vision, particularly in one eye
• Loss of speech or trouble talking or understanding speech
• Sudden, severe headache a bolt out of the blue with no apparent cause
• Unexplained dizziness, unsteadiness or a sudden fall, especially if accompanied by any of the other symptoms

Domestic pets cause most animal bites, with dogs more likely to bite than cats. Cat bites, however, are more likely to cause infection. Bites from nonimmunized domestic animals and wild animals carry the risk of rabies. Rabies is common in raccoons, skunks, bats and foxes; rabbits and squirrels rarely harbor rabies. If you or your child is bitten by an animal, follow these guidelines:

• If the bite barely breaks the skin, treat it as a minor wound. Wash the wound thoroughly with soap and water. Apply an antibiotic cream to prevent infection and cover it with a clean bandage.
• If the bite creates a deep puncture of the skin or the skin is badly torn and bleeding, apply pressure to stop the bleeding and see your doctor.
• If you notice signs of infection such as swelling, redness, increased pain or oozing, see your doctor immediately.
• If you suspect the bite was caused by an animal that might harbor rabies any unprovoked bite from a wild or domestic animal of unknown immunization status see your doctor immediately.

Doctors recommend you get a tetanus shot every 10 years. If your last one was more than 5 years ago and your wound is deep or dirty, your doctor may recommend a booster. You should have the booster within 48 hours of the injury.

                Human Bites   

Human bites can often be as dangerous or more dangerous than animal bites because of the types of bacteria and viruses contained in the human mouth.

If you sustain a human bite that breaks the skin:

1. Stop the bleeding by applying pressure.
2. Wash the wound thoroughly with soap and water.
3. Apply an antibiotic cream to prevent infection.
4. Apply a clean bandage.
5. Get emergency medical care.

Insect Bites and Stings

Symptoms of an insect bite result from the injection of venom or other agent into your skin. The venom triggers an allergic (immune) reaction. The severity of your reaction depends on your sensitivity to the insect venom or agent.

Most reactions are mild, causing little more than an annoying itching or stinging sensation and mild swelling that disappear within a day or so. A delayed reaction may cause fever, painful joints, hives and swollen glands. You might experience both the immediate and the delayed reactions from the same bite or sting. Only a small percentage of people develop severe reactions to insect venom.

Bees, wasps, hornets, yellow jackets and fire ants are typically the most troublesome insects. Mosquitoes, ticks, biting flies and some spiders can also cause reactions, but these are generally milder.

For mild reactions:

1. Move to a safe area to avoid more stings.
2. Try to remove the stinger by scraping or brushing it off with a firm edge, such as a credit card. Swab the site with disinfectant.
3. To reduce pain and swelling, apply ice or a cold pack.
4. Apply 0.5 percent or 1 percent hydrocortisone cream, calamine lotion or a baking soda paste to the bite or sting several times a day until your symptoms subside.
5. Take an antihistamine such as diphenhydramine (Benadryl, Tylenol Severe Allergy) or chlorpheniramine maleate (Chlor-Trimeton, Teldrin).

For severe reactions:

Severe reactions may progress rapidly. Dial 911 or call for emergency medical assistance if you experience any of the following signs or symptoms:

• Difficulty breathing
• Swelling of the lips or throat
• Faintness
• Confusion
• Rapid heartbeat
• Hives
• Nausea, cramps and vomiting

While waiting for emergency transportation:

1. Have the person lie down. If unconscious and breathing, lay the person on his or her side to allow drainage from the mouth.
2. If there is no breathing, movement or response to touch, begin cardiopulmonary resuscitation.
3. Check to see if the person is carrying an allergy kit containing epinephrine. Follow instructions on the kit.

Less severe allergic reactions include mild nausea and intestinal cramps, diarrhea or swelling larger than 2 inches in diameter at the site. See your physician promptly if you experience any of these symptoms.

                Snakebites     

Most snakes are not poisonous. A few exceptions include the rattlesnake, coral snake, water moccasin and copperhead. Most poisonous snakes have slit like eyes. Their heads are triangular, with a depression or pit midway between the eyes and nostrils on both sides of the head. Some nonpoisonous snakes, however, also have slit like eyes.

Other characteristics unique to certain poisonous snakes:

• Rattlesnakes make a rattling sound by moving the rings at the end of their tail.
• Water moccasins have a whitish, cottony lining in their mouth.
• Coral snakes have red, yellow and black rings along their length.

To reduce your risk of snakebites, avoid picking up or playing with any snake unless you are properly trained.

If you're bitten by a snake:

• Don't try to capture the snake.
• Immobilize the arm or leg that was bitten and elevate it.
• Don't cut the wound or attempt to remove the venom.
• Seek medical attention as soon as possible, especially if the area changes color, begins to swell or is painful.

Spider Bites                      

Only a few spiders are dangerous to humans. Two of those are the black widow and the brown recluse. Both prefer warm climates and dark, dry places where flies are plentiful. They often live in dry, littered and undisturbed areas such as closets, woodpiles and under sinks.

Black widow spider
The female black widow is the one that gives the serious bite. It is not lethal unless a young child is bitten. You can identify this spider by the red hourglass marking on its belly. The bite feels like a pinprick you may not even know you've been bitten. At first you may notice only slight swelling and faint red marks. Within a few hours, though, intense pain and stiffness begin. Other symptoms include:

• Chills
• Fever
• Nausea
• Severe abdominal pain

Brown recluse spider
You can identify this spider by the violin-shaped marking on its top. The bite produces a mild stinging, followed by local redness and intense pain within 8 hours. A fluid-filled blister forms at the site and then sloughs off to leave a deep, growing ulcer. Reactions vary from a mild fever and rash to nausea and listlessness. On rare occasions death results.

If bitten by a spider:

Clean the site well with soap and water. Apply a cool compress over the bite location and keep the affected limb elevated to about heart level. Aspirin or acetaminophen (Tylenol, aspirin free Excedrin) may be used to relieve minor symptoms in adults. Do not give aspirin to children. Give them acetaminophen instead. Treatment in a medical facility may be necessary for children less than 6 years old or for adults with severe symptoms.

If bitten by a brown recluse or black widow spider:

1. Make a positive identification. If the bite is on an arm or a leg, place a snug bandage above the bite to help slow or halt the venom's spread. Ensure that the bandage is tight enough to slow the flow of blood at skin level but not so tight as to cut off circulation in the arm or the leg.
2. Apply a cloth dampened with cold water or filled with ice.
3. Seek immediate medical attention.

Tick Bites                          

Some ticks transmit bacteria that cause illnesses such as Lyme disease or Rocky Mountain spotted fever. Your risk of contracting one of these diseases depends on what part of the United States you live in, how much time you spend in wooded areas and how well you protect yourself.

If you've been bitten by a tick:

1. Remove the tick promptly and carefully. Use tweezers to grasp the tick by its body and pull gently to remove the whole tick without crushing it.
2. If possible, seal the tick in a plastic bag and keep it in case you later need to see your doctor. Otherwise flush the tick down the toilet or bury it.
3. Wash your hands after handling the tick.

See your doctor if you develop:

• Rash
• Fever
• Muscle aches
• Joint pain and swelling

If possible, bring the tick with you to your doctor's appointment.

Severe Bleeding

To stop severe bleeding:

1. Have the injured person lie down. If possible, position the person's head slightly lower than the trunk or elevate the legs. This position reduces the risk of fainting by increasing blood flow to the brain. If possible, elevate the site of bleeding.
2. Remove any obvious dirt or debris from the wound. Do not remove any objects pierced into the victim. Do not probe the wound or attempt to clean it at this point. Your principal concern is to stop the bleeding.
3. Apply pressure directly on the wound with a sterile bandage, clean cloth or even a piece of clothing. If nothing else is available, use your hand.
4. Maintain pressure until the bleeding stops. When it does, bind the wound tightly with adhesive tape or a bandage. If none is available, use a piece of clean clothing.
5. If the bleeding continues and seeps through the gauze or other material you are holding on the wound, do not remove it. Instead, add more absorbent material on top of it.
6. If the bleeding does not stop with direct pressure, apply pressure to the artery delivering blood to the area of the wound. In the case of a wound on the hand or lower arm, for example, squeeze the main artery in the upper arm against the bone. Keep your fingers flat. With your other hand, continue to exert pressure on the wound itself.
7. Immobilize the injured body part once the bleeding has stopped. Leave the bandages in place and get the injured person to the emergency room as soon as possible.

Broken Bone

After injury or trauma, dial 911 or call for emergency medical assistance if:

• The person is unresponsive, isn't breathing and isn't moving. Begin cardiopulmonary resuscitation (CPR).
• There is heavy bleeding.
• Even gentle pressure or movement causes pain.
• The limb or joint appears deformed or the bone has pierced the skin.
• The part of the injured arm or leg farthest from the heart, such as a toe or finger, is numb or bluish at the tip.

Take these precautions immediately while waiting for medical help:

1. Stop the bleeding. If there is bleeding, press directly on the wound with a sterile bandage, a clean cloth or a piece of clothing. Try to elevate the injured area above the heart to reduce bleeding and swelling. Apply pressure until the bleeding stops.
2. Immobilize the area. Keep the joints above and below the fracture immobilized, but don't try to set the bone. A splint stabilizes the damaged parts and prevents unwanted movement, which could aggravate tissue damage. Proper splinting may reduce pain. The less movement of the affected area, the better.
   
   To design a splint, use a rigid material such as wood, plastic or metal. The splint should be longer than the bone it is splinting and extend below and above the injury. Pad the splint with gauze wherever possible. Pads make the splint more comfortable and help keep the bones straight.
   
   Fasten the splint to the limb with gauze or strips of cloth or string. Start wrapping from the extremity and work toward the body. Splint the limb firmly to prevent motion but not tight enough to stop blood flow.
   
   To splint the lower portion of an arm (forearm): Tie rolled magazines or newspapers around the forearm. Wrap a sling over the shoulder and a band around the sling to help keep the elbow still.
   
   To splint the lower portion of a leg (shinbone): Place the entire leg between two splints. If no splints are available, use the healthy leg as a splint to impede movement of the broken one. If the thighbone is broken, immobilize the hip joint by gently moving the person onto a rigid surface such as a tabletop or door.
3. Apply cold. If ice is available, wrap the ice in cloth and apply it to the splinted limb.
4. Treat for shock. If the person becomes faint or is breathing in short breaths, he or she may be in shock. Lay the person down with the head slightly lower than the trunk and elevate the legs.

Bruise

A bruise forms when a blow breaks small blood vessels near the skin's surface, allowing a small amount of blood to leak out under the skin. The trapped blood appears as a black-and-blue mark. Sometimes, there are also tiny red dots or red splotches.

If the skin isn't broken, a bandage isn't necessary. You can, however, enhance healing with these simple steps:

• Elevate the injured area.
• Apply ice or a cold pack for 30 to 60 minutes at a time for a day or two after the injury.

See your doctor if:

• You have unusually large or painful bruises particularly if your bruises seem to develop for no known reasons.
• You bruise easily and you're experiencing abnormal bleeding elsewhere, such as from your nose or gums.
• You have no history of bruising but suddenly experience bruises.

These signs and symptoms may indicate a more serious problem, such as a blood-clotting problem or blood-related disease. Bruises accompanied by persistent pain or headache also may indicate a more serious underlying illness and require medical attention.

Burns                                 

To distinguish a minor burn from a serious burn, determine the degree and extent of damage to body tissues. These three classifications will help you determine emergency care:

First-degree
The least serious burns are those in which only the outer layer of skin (epidermis) is burned. The skin is usually red, with swelling and pain sometimes present. The outer layer of skin has not been burned through, though. Treat a first-degree burn as a minor burn unless it involves substantial portions of the hands, feet, face, groin, buttocks or a major joint.

Second-degree
When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned, the injury is termed second-degree. Blisters develop and the skin takes on an intensely reddened, splotchy appearance. Second-degree burns produce severe pain and swelling.

If the burn is no larger than 2 to 3 inches in diameter, treat it as a minor burn. If the burned area is larger or if the burn is on the hands, feet, face, groin, buttocks or a major joint, get medical help immediately.

For minor burns, including second-degree burns limited to an area no larger than 2 to 3 inches in diameter, take the following action:

1. Cool the burn. Hold the burned area under cold running water for 15 minutes. If this is impractical, immerse the burn in cold water or cool it with cold compresses. Cooling the burn reduces swelling by carrying heat away from the skin.
2. Consider a lotion. Once a burn is completely cooled, a lotion, such as one containing aloe vera, or a moisturizer prevents drying and makes you feel more comfortable.
3. Cover the burn with a sterile gauze bandage. Don't use fluffy cotton, which may irritate the skin. Wrap the gauze loosely to avoid putting pressure on burned skin. Bandaging keeps air off the area, reduces pain and protects blistered skin.
4. Take an over-the-counter pain reliever. These include aspirin, ibuprofen, naproxen or acetaminophen.

Minor burns usually heal in about 1 to 2 weeks without further treatment. They may heal with pigment changes, meaning the healed area may be a different color than the surrounding skin. Watch for signs of infection such as increased pain, redness, fever, swelling or oozing. Infection will cause poor healing and further damage. If infection develops, get medical help immediately. Avoid re-injuring or tanning if the burns are less than a year old doing so may cause more extensive pigmentation changes.

Caution

• Do not use ice. Putting ice directly on a burn can cause frostbite, further damaging your skin.
• Do not break blisters. Fluid-filled blisters protect against infection. If blisters break, wash the area with mild soap and water, then apply an antibiotic ointment and a gauze bandage. Clean and change dressings daily.

Third-Degree
The most serious burns are painless and involve all layers of the skin. Fat, muscle and even bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning or other toxic effects may occur if smoke inhalation accompanied the burn.

For major burns, dial 911 or call for emergency medical assistance. Until an emergency unit arrives, follow these steps:

• Don't remove burnt clothing. Do make sure the victim is no longer in contact with smoldering materials or exposed to significant smoke or heat.
• Make sure the burn victim is breathing. If breathing has stopped or you suspect the person's airway is blocked, try to clear the airway or do CPR.
• Cover the area of the burn with a cool, moist sterile bandage or clean cloth.

• Chemical                                            

If a chemical burns the skin:

1. Remove the cause of the burn by flushing the chemicals off the skin surface with cool, running water for 20 minutes or more. If the burning chemical is a powderlike substance such as lime, brush it off the skin before flushing.
2. Remove clothing or jewelry that has been contaminated by the chemical.
3. Wrap the burned area with a dry, sterile dressing or a clean cloth.
4. Rinse the burn again for several more minutes if the victim complains of increased burning after the initial washing.

Minor chemical burns usually heal without further treatment.

Seek emergency medical assistance if:

• The victim has symptoms of shock, such as fainting, pale complexion or breathing in a notably shallow fashion
• The chemical burned through the first layer of skin and the resulting second-degree burn covers an area more than 2 to 3 inches in diameter
• The chemical burn occurred on the eye, hands, feet, face, groin, buttocks or a major joint

If you are unsure whether a substance is toxic, call the poison control center.

• Electrical                   

An electrical burn may appear minor, but the damage can extend deep into the tissues beneath the skin. If the amount of electrical current that passed through the body was large, internal damage such as a heart rhythm disturbance or cardiac arrest can occur.

Sometimes the jolt associated with the electrical injury can cause you to be thrown or to fall, resulting in fractures or other associated injuries. Dial 911 or call for emergency medical assistance.

While waiting for medical help, follow these steps:

1. Ensure the person is breathing. If breathing has stopped or you suspect the person's airway is blocked, begin cardiopulmonary resuscitation (CPR).
2. If the person is breathing, cover any burned areas with a sterile gauze bandage, if

available, or a clean cloth. Don't use a blanket or towel. Fluffy fibers can be irritating.

Cardiopulmonary Resuscitation (CPR)

Cardiopulmonary resuscitation (CPR) involves a combination of mouth-to-mouth rescue breathing and chest compression. CPR keeps oxygenated blood flowing to the brain and other vital organs until appropriate medical treatment can restore a normal heart rhythm.

Before starting CPR, assess the situation:

• Is the person conscious or unconscious? CPR is only performed when a person is unconscious and is not moving or is not breathing normally.
• Position the person so you can check for breathing and a pulse by laying the victim flat on a firm surface and extending the neck.
• If the person appears unconscious, tap or shake his or her shoulder and ask loudly, "Are you OK?"
• If the person does not respond, follow the steps below and get help by dialing 911 or calling for emergency medical assistance. If you cannot leave the scene, have someone else call.

1. Breathing. Mouth-to-mouth rescue breathing is the quickest way to get oxygen into a person's lungs.
2. Circulation. Chest compressions replace the heartbeat when it has stopped. Compressions help maintain some blood flow to the brain, lungs and heart. You must perform rescue breathing anytime you perform chest compressions.

To perform CPR:

1. Lay the person flat on a firm surface and extend the neck.
2. Open the victim's mouth and airway by lifting the chin forward.
3. Determine whether the victim is breathing by simultaneously listening for breath sounds, feeling for air motion on your cheek and ear and looking for chest motion.
4. If the victim is not breathing, pinch his or her nostrils closed, make a seal around the mouth and breathe into his or her mouth twice. Give one breath every 5 seconds and completely refill your lungs after each breath.
5. If there is no pulse, begin chest compressions. Place your hands over the lower part of the breastbone, keep your elbows straight and position your shoulders directly above your hands to make the best use of your weight.
   
   Push down 1 1/2 to 2 inches at a rate of 80 to 100 times a minute. The pushing down and letting up phase of each cycle should be equal in duration. Don't jab down and relax. After 15 compressions, breathe into the victim's mouth twice.
   
   After every four cycles of 15 compressions and two breaths, recheck for a pulse and breathing. Continue the rescue maneuvers as long as there is no pulse or breathing.

To perform CPR on a baby:

1. Cover the mouth and nose with your mouth.
2. Give one breath for every five chest compressions.
3. Compress the chest 1/2 to 1 inch at least 100 times a minute, using only two fingers.

The above is just a brief description of CPR. To learn CPR, take a first-aid training course. Many organizations, such as the Red Cross and the American Heart Association, sponsor such courses.

Chemical Splash

If a chemical splashes into the eye:

1. Flush the eye with water immediately. Flushing will dilute the chemical. Use any source of clean drinking water. It is more important to begin flushing than it is to find sterile water.
2. Continue to flush the eye for at least 20 minutes, particularly if the eye is exposed to household cleaners that contain ammonia.
3. Seek emergency medical assistance if symptoms such as pain, burning or visual blurring persist.
4. Follow any special directions on the chemical label. Some chemical splashes should be evaluated by a physician even if they do not cause symptoms.

Chest Pain

Chest pain is among the most difficult symptoms to interpret. Cause of the pain can vary from minor problems, such as indigestion and stress, to serious medical emergencies, such as a heart attack.

As with other sudden, unexplained pain, chest pain may be a signal for you to get medical help. Use this information to help you determine whether your chest pain is a medical emergency:

Heart attack
A heart attack occurs when an artery that supplies oxygen to your heart muscle becomes blocked. A heart attack generally causes chest pain for more than 15 minutes. But a heart attack also can be silent and have no symptoms.

About half of heart attack victims have warning symptoms hours, days or weeks in advance. The earliest predictor of an attack may be recurrent chest pain that's triggered by exertion and relieved by rest.

The American Heart Association lists these warning signs of a heart attack. Be aware that you may not have all of them, and that symptoms may come and go.

• Uncomfortable pressure, fullness or squeezing pain in the center of your chest lasting more than a few minutes
• Pain spreading to your shoulders, neck or arms
• Light-headedness, fainting, sweating, nausea or shortness of breath

If you or someone else may be having a heart attack:

• Dial 911 or call for emergency medical assistance. If you live in a rural or large metropolitan area, having someone drive you to the hospital may be faster. If you think you're having a heart attack, ask someone to drive you. Never drive yourself.
• Chew aspirin. Take one regular-strength aspirin and chew it to speed absorption.
• Begin CPR. If the person suspected of having a heart attack is unconscious, a 911 dispatcher or another emergency medical specialist may advise you to begin cardiopulmonary resuscitation (CPR). Even if you're not trained, a dispatcher can instruct you in CPR until help arrives.

Pulmonary embolism
An embolus is an accumulation of foreign material, usually a blood clot, that blocks an artery. Tissue death occurs when the tissue supplied by the blocked artery is damaged by the sudden loss of blood. Pulmonary embolism describes the condition that occurs when a clot usually from the veins of the leg or pelvis lodges in the lung.

Symptoms of pulmonary embolism include:

• Sudden, sharp chest pain that begins or worsens with a deep breath or a cough, often accompanied by shortness of breath
• Sudden, unexplained shortness of breath without pain
• Cough that may produce blood-streaked sputum
• Rapid heartbeat
• Anxiety and excessive perspiration

As with a suspected heart attack, dial 911 or call for emergency medical assistance immediately.

Pneumonia with pleurisy
A frequent symptom of pneumonia is chest pain accompanied by chills, fever and a cough that may bring up bloody or foul-smelling sputum. When pneumonia occurs with an inflammation of the membranes (pleura) that surround the lung, you may have considerable chest discomfort when inhaling or coughing. This condition is called pleurisy.

One sign of pleurisy is that the pain is usually relieved temporarily by holding your breath or putting pressure on the painful area of your chest. This is not true of a heart attack. See your doctor if a cough and fever or chills accompany your chest pain. Pleurisy, however, isn't a medical emergency.

Chest wall pain
One of the most common varieties of harmless chest pain is chest wall pain. One kind of chest wall pain is costochondritis. It consists of pain and tenderness in and about cartilage that connects your ribs to your breastbone (sternum).

Often, pressure over a few points along the margin of the sternum demonstrates remarkable tenderness limited to these small areas. If the pressure of the examining finger duplicates your pain, you probably can conclude that a serious cause of chest pain, such as a heart attack, is not responsible.

Other causes of chest wall pain include:

Strained muscles from overuse or excessive coughing

Muscle bruising from minor trauma

Choking

In adults, choking is often the result of inadequately chewed food becoming lodged in the throat or windpipe. Most often, solid foods such as meat are the cause.

People who are choking usually have been talking while simultaneously chewing a piece of meat. Young children will put most anything in their mouth, so choking can occur unassociated with a meal.

Wearing dentures increases the risk of choking because it makes it more difficult to thoroughly chew food they exert less chewing pressure than natural teeth and they interfere with the way food feels in the mouth. Drinking alcohol also increases the risk of choking while eating.

Panic accompanies choking. The choking victim's face often assumes an expression of fear or terror. At first he or she may turn purple, the eyes may bulge and he or she may wheeze or gasp. If the person can cough freely, has normal skin color and can speak, he or she is not choking. If the cough is more like a gasp and the person is turning blue, he or she is probably choking. If in doubt, ask the choking person if he or she can talk. If the person can speak, then the windpipe is not completely blocked and oxygen is reaching the lungs. A person who is choking is unable to communicate except by hand motions.

The universal sign for choking is a hand clutched to the throat, with thumb and fingers extended. If a person displays this sign, dial 911 or call for emergency medical assistance. Don't leave the person unattended.

If some food "goes down the wrong pipe," the coughing reflex often will resolve the problem. If it doesn't, you will need to help the victim remove the airway obstruction.

To prepare yourself for such situations, learn the Heimlich maneuver in a certified first-aid training course.

To perform the Heimlich maneuver on someone else:

1. Stand behind the choking person and wrap your arms around his or her waist. Bend the person slightly forward.
2. Make a fist with one hand and place it slightly above the person's navel.
3. Grasp your fist with the other hand and press hard into the abdomen with a quick, upward thrust. Repeat this procedure until the object is expelled from the airway.

To perform the Heimlich maneuver on yourself:

1. Position your own fist slightly above your navel.
2. Grasp your fist with your other hand and thrust upward into your abdomen until the object is expelled, or lean over the back of a chair to produce this effect.

Corneal Abrasion

The cornea is the clear, protective "window" at the front of your eye. You can scratch or cut your cornea by contact with dust, dirt, sand, wood shavings, metal particles or even the edge of a piece of paper Usually the scratch is just on the surface of the cornea (superficial).

Because the cornea is extremely sensitive, abrasions are usually very painful. If your cornea is scratched, it might feel as though you have sand in your eye. Tears, blurred vision, sensitivity or redness around the eye can suggest a corneal abrasion.

To prevent injury, always wear safety glasses when working with wood, metal or sand or around dirt. If you are injured:

Get medical attention as soon as possible.

Run lukewarm tap water over your eye or splash your eye with clean water. Rinsing your eye may wash out the offending foreign body.

Blink several times. This movement may remove small particles of dust or sand.

Pull your upper eyelid over your lower eyelid. The lashes of your lower eyelid can sometimes brush the foreign body from the undersurface of your upper eyelid.

Don't apply patches or ice packs to your eye. If you get an object within the eye itself typically when hammering metal on metal do not press on your eyeball.

Don't rub your eye after an injury. This action can worsen a corneal abrasion.

Cuts and Scrapes

Minor cuts and scrapes usually don't require a trip to the emergency room. Yet proper care is essential to avoid infection or other complications. These guidelines can help you care for simple wounds:

1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. If the blood spurts or continues to flow after several minutes of pressure, seek emergency medical assistance.
2. Clean the wound. Rinse the wound with clear water. Don't use soap it can irritate the wound. If dirt or debris remain in the wound after washing, use tweezers cleaned with alcohol to remove the particles. If debris remains embedded in the wound after cleaning, see your doctor. Don't attempt to remove particles by yourself.
   
   Thorough wound cleaning reduces the risk of tetanus. To clean the area around the wound, use soap and a washcloth. You can use hydrogen peroxide, iodine or an iodine-containing cleanser, but these substances irritate living cells. Don't apply them directly on the wound.
3. Apply antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. The products don't make the wound heal faster, but they can discourage infection and allow your body's healing factors to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
4. Cover the wound. Exposure to air speeds healing, but bandages can help keep the wound clean and keep harmful bacteria out. Cover blisters that are draining until a scab forms.
5. Change the dressing. Change the dressing at least daily or whenever it becomes wet or dirty. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape. These supplies generally are available at pharmacies.
6. Get stitches. A wound that cuts deeply through the skin or is gaping or jagged-edged may require stitches. A strip or two of surgical tape may hold a minor cut together, but if you can't easily close the mouth of the wound, see your doctor. Proper closure also minimizes scarring.
7. Watch for signs of infection. See your doctor if the wound isn't healing or you notice any redness, drainage, warmth or swelling.
8. Get a tetanus shot. Doctors recommend you get a tetanus shot every 10 years. If your wound is deep or dirty and your last shot was more than 5 years ago, your doctor may recommend a booster. You should get the booster within 48 hours of the injury.

     Dislocation

A dislocation is an injury in which the ends of your bones are forced from their normal positions. The cause is usually trauma, such as a blow or fall, but can be an underlying disease such as rheumatoid arthritis.

Dislocations are common injuries in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing and volleyball. Dislocations may occur in your major joints your shoulder, hip, knee, elbow or ankle or in smaller joints; for instance, your finger, thumb or toe. The injury will temporarily deform and immobilize your joint and may result in sudden and severe pain. A dislocation requires prompt medical attention to return your bones to their proper positions.

If you believe you have dislocated a joint:

1. Get medical help immediately.
2. Until you receive help, splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels.
3. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the buildup of fluids in and around the injured joint.

• Fainting

Fainting occurs when the blood supply to your brain is momentarily inadequate, causing you to lose consciousness. Loss of consciousness is usually brief.

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

If you feel faint:

1. Lie down or sit down.
2. Place your head between your knees.

Discuss recurrent fainting spells with your doctor.

If someone else faints:

1. Position the person on his or her back, with the legs elevated above the heart level.
2. Watch the airway carefully. People who lose consciousness frequently vomit.
3. Position your ear over the person's mouth to listen for breathing sounds. If breathing stopped, the problem is more serious than a fainting spell. Initiate cardiopulmonary resuscitation (CPR). Get emergency medical care. Call 911 if available.
4. If the person is breathing, restore blood flow to the brain by raising the person's legs above the level of the head. Loosen belts, collars or other constrictive clothing. The person should revive quickly. If the person does not regain consciousness in 1 to 2 minutes, dial 911 or call for emergency medical assistance.
   
   If the person was injured in a fall associated with a faint, treat any bumps, bruises or cuts appropriately. Control bleeding with direct pressure. If teeth are knocked out, cover the area with gauze.

Fever

Fever is one of your body's reactions to infection. Usually body temperature doesn't exceed 99 F. The value of 98.6 F as normal body temperature is only a general guide. Elevated temperatures usually aren't dangerous in an adult until they reach 103 F. Taking aspirin or acetaminophen (Tylenol, Excedrin) will usually reduce a fever in adults.

Get medical help in these cases:

If the child is 3 months or younger

If the child has a temperature of 103 F

If the adult has a temperature of at least 103 F or a temperature of 101 F that persists for longer than 3 days

If severe headache, stiff neck, swelling of the throat or mental confusion accompanies the fever

If you see unusual rashes or bite marks

If there are no apparent signs or symptoms except a temperature of 101 F that lasts more than 3 days or a low fever that lasts for several weeks

Food Poisoning

All foods naturally contain small amounts of bacteria. But when food is poorly handled, improperly cooked or inadequately stored, bacteria can multiply in great enough numbers to cause illness.

Parasites, viruses and chemicals can also contaminate food. Foodborne illness from these sources, however, is less common.

Signs and symptoms of food poisoning vary with the source of contamination. Generally diarrhea, nausea, abdominal pain and sometimes vomiting occur within hours of eating contaminated food.

If you eat contaminated food, whether you become ill depends on the organism, the amount of exposure, your age and your health. High-risk groups include:

• Older adults. As you get older, your immune system may not respond as quickly and effectively to infectious organisms.
• Infants and young children. Their immune systems haven't fully developed.
• People with chronic disease. Having a chronic condition, such as diabetes or AIDS, or receiving chemotherapy or radiation therapy for cancer reduces your immune response.

If you develop food poisoning:

• Rest and drink plenty of liquids.
• Don't use antidiarrheal medications because they may slow elimination of bacteria from your system.

Mild to moderate illness often resolves on its own.

Dial 911 or call for emergency medical assistance if:

• You have severe symptoms, such as watery diarrhea that turns bloody within 24 hours.
• You belong to a high-risk group.
• You suspect botulism poisoning. Botulism is a potentially fatal food poisoning that results from the ingestion of a toxin formed by certain spores in food. Botulism toxin is most often found in home-canned foods. Signs and symptoms usually begin 12 to 36 hours after eating the contaminated food and may include headache, blurred vision, muscle weakness and eventual paralysis. Some people also have nausea and vomiting, constipation, urinary retention, difficulty breathing and dry mouth.

Foreign Object