Clinical Reference Systems: Pediatric Advisor 10.0
First Aid Measures for Emergencies
The following recommendations will help you care for your
child's minor emergencies and provide first aid for your
child's major emergencies while you are waiting for medical
assistance. Also, take a first aid course. You can't learn
CPR (cardiopulmonary resuscitation) just by reading.
- Animal bites
Immediately wash the bite with lots of soap and water for
10 minutes.
Many dog bites can be prevented by teaching a child not
to pet strange dogs, not to tease dogs, and not to go
near his own dog when the dog is eating or fighting.
Also, teach your child not to pick up sick or injured
wild animals.
- Bee stings (Note: Yellow jackets and wasps don't leave
stingers.)
Carefully remove the stinger by scraping it off without
squeezing it. Use the edge of a knife blade or credit
card. Then put a few drops of water on the area of the
sting, sprinkle on meat tenderizer, and massage the
solution into the skin for 10 minutes. Don't use meat
tenderizer near the eye. Putting an ice cube on the area
will also relieve pain.
Call your child's physician if your child develops hives
or has difficulty breathing.
- Tick bites
The simplest and quickest way to remove a tick is to pull
it off. Use tweezers to grasp the tick as close to the
skin as possible. Pull steadily upward until the tick
releases its grip. Do not twist the tick or squeeze the
tweezers so much that you crush the tick.
If you don't have tweezers, pull the tick off in the same
way by using your fingers. If you remove the body but
leave the head in the skin, remove the head by using a
sterile needle (in the same way you would remove a
sliver). Wash the wound and your hands with soap and
water after you remove the tick.
A recent study showed that embedded ticks do not back out
when covered with petroleum jelly, fingernail polish, or
rubbing alcohol. Applying a hot match to the tick also
does not work. If you aren't successful in completely
removing the tick, call your child's physician. Most
ticks do not cause disease. However, if your child
develops fever, rash, or other symptoms during the week
after the bite, call your child's physician.
- Bleeding, severe
Determine whether an artery or a vein has been cut. When
an artery is cut, the blood pumps or spurts from the
wound with each heartbeat. When a major vein is cut, the
blood runs out of the wound at a steady rate.
If an artery is cut and you know the arterial pressure
points, apply strong pressure to the artery between the
wound and the heart until help arrives. If you do not
know the arterial pressure points, place several sterile
dressings or the first clean cloth at hand (towels,
sheets, or shirts) over the wound and apply direct
pressure over the wound immediately. For arterial
bleeding, the pressure must be forceful and continuous,
often applied with the palm of the hand. Act quickly
because the ongoing blood loss can cause shock.
If a vein is cut, place several sterile dressings or the
first clean cloth at hand (towels, sheets, or shirts)
over the wound and apply direct pressure over the wound.
After about 10 minutes of pressure, the dressings can
often be bandaged in place until the child arrives at an
emergency room.
- Breathing, stopped
Call the rescue squad (911) and begin mouth-to-mouth
resuscitation.
- Burns
Immediately (within 10 seconds of the burn) immerse the
burn in cold tap water for at least 5 minutes. If this
is impossible (for example, if the burn is on the face
and trunk), apply cool wet cloths or pour a pan of cold
tap water over the burn. This will lessen the depth of
the burn and relieve pain.
Do not put butter or burn ointment on the burn. Do not
break blisters.
After you have cooled the burn, call your child's
physician for further instructions.
- Choking
Most children occasionally choke on liquids that go down
the windpipe instead of the esophagus. Your child's
cough reflex will clear the windpipe of the liquid within
10 to 30 seconds. It is best if you do nothing except
reassure your child.
Sometimes a young child will suddenly choke on a peanut,
raw carrot, or other piece of food. If your child is
coughing and able to breathe, encourage him to cough the
material up by himself.
If your child can't breathe, cough, or make a sound,
proceed with high abdominal thrusts, called the Heimlich
maneuver. Grasp your child from behind, just below the
lower ribs but above the navel, in bear-hug fashion.
Give a sudden, upward jerk at a 45-degree angle to try to
squeeze all the air out of his chest and pop the lodged
object out of his windpipe. Repeat this upward abdominal
thrust 10 times in rapid succession. If your child is
too heavy for you to suspend from your arms, lay him on
his back on the floor. Put your hands on both sides of
his abdomen, just below the ribs, and apply sudden
strong bursts of upward pressure.
If your child is less than 1 year old, first use back
blows. Place him face down at a 60-degree angle over
your knees. (Gravity may help propel the object out.)
Deliver 5 hard blows with the heel of your hand to the
area between your child's shoulder blades. If this is
not successful, lay him on his back and give 5 rapid
chest compressions over the lower sternum (breast bone)
using two fingers. If he still hasn't started
breathing, begin mouth-to-mouth resuscitation and call
the rescue squad (911).
- Convulsions with fever
Bringing your child's fever down as quickly as possible
will shorten the seizure. Remove most of your child's
clothing and apply cold washcloths to her forehead and
neck. Sponge her body with cool water. (Do not use
rubbing alcohol.) As the water evaporates, your child's
temperature will fall.
When the seizure is over and your child is awake, give
her an appropriate dose of acetaminophen or ibuprofen
and encourage her to drink cool fluids. If your child
starts to vomit, place her on her side or abdomen. If
her breathing becomes noisy, pull her jaw and chin
forward by placing a finger behind the corner of her jaw
on each side. Don't put anything into her mouth. Have
someone call your physician.
- Drowning
Begin mouth-to-mouth breathing as soon as possible, in
a boat, a life preserver, or at the latest, when the
rescuer reaches shallow water. Continue rescue breathing
until the child reaches a medical facility. Some
children have survived long submersions, especially in
cold water.
If there is any possibility of a neck injury (for example,
a diving accident), protect the neck from any bending or
twisting.
- Eye, chemical in
Most chemicals such as alcohol or hydrocarbons (for
example, gasoline or lighter fluid) cause only temporary
stinging and superficial irritation. However, acids and
alkalis splashed into the eye can severely damage the
cornea. When any chemical is accidentally splashed into
your child's eye, treat it as an emergency until your
physician or a Poison Control Center expert tells you
otherwise.
Immediate and thorough irrigation of the eye with tap
water is essential to prevent damage to the cornea. (Do
not use antidotes such as vinegar.) Hold your child's
face up under gently running tap water. Or have your child
lie down while you continuously pour lukewarm water from
a pitcher or glass into his eye. It is very important to
try to hold your child's eyelids open during this
process. For most chemicals, you should irrigate the eye
for 5 minutes; for acids, 10 minutes; and for alkalis,
20 minutes.
- Eye, foreign body in
If the particle is in the corner of your child's eye, try
to remove it with the corner of a clean cloth or a
moistened cotton swab. If the particle is under your
child's eyelid, try to remove it by opening and closing
her eye several times while her eye is submerged in a cup
of water. If the object stays on the lid and you can see
it, try to remove it with a moistened cotton swab. If
you can't see the particle or remove it, call your
child's physician.
- Fracture, suspected
If you think your child has broken a bone, take him in
for a medical exam and an x-ray. Don't let your child
put weight or pressure on the bone. Put a splint on the
suspected fracture before you move your child so the
edges of the fracture won't damage blood vessels.
- Shoulder or arm: Use a sling made of a triangular
piece of cloth to support the forearm at an 80- to
90-degree angle to the upper arm. If you can't make a
sling, at least support the injured part with the
other hand.
- Leg: After placing a towel between the legs for
padding, use the uninjured leg as a splint by binding
the thighs and legs together with straps. If you
can't do this, at least carry your child and don't
permit him to put any weight on the injured leg.
- Neck: Protect the neck from any turning or bending.
Do not move your child until a neck brace or spine
board has been applied. Call a rescue squad (911) for
transportation.
- Sprained ankle or knee
Remember the acronym RICE for treatment of most sports
injuries: rest, ice, compression, and elevation.
Apply continuous compression by wrapping a wet elastic
bandage around the ankle or knee. Numbness, tingling,
or increased pain means the bandage is too tight. Keep
the bandage on for 24 to 48 hours.
Put a plastic bag of crushed ice on the ankle or knee.
Do this 20 minutes of every hour while your child is
awake for the first 1 or 2 days after the injury. Ice
and compression reduce bleeding, swelling, and pain.
Keep the injured ankle or knee elevated and at rest for
24 hours.
Call your child's physician for further instructions.
- Poisoning
If your child has swallowed something poisonous, first
sweep any pills or solid poisons out of your child's
mouth with your finger. Then, if your child swallowed a
chemical, immediately give her one glass of water or milk
to rinse her esophagus; this is not necessary if your
child swallowed a medicine. Call the nearest Poison
Control Center or your child's physician for advice.
Don't induce vomiting unless you are certain it is
necessary and safe to do so. Vomiting is harmful if your
child has ingested acids, alkalis, or petroleum products
(for example, kerosene, furniture polish, or lighter
fluids). The best way to induce vomiting is with syrup
of ipecac. Gagging alone rarely works. A bottle of
syrup of ipecac usually contains 1 ounce. Give a 1-
tablespoon dose; give 2 tablespoons if your child is over
age 6 years. Also give your child 6 ounces or more of
water or other fluid and keep him walking about to help
the ipecac work faster. If your child hasn't vomited
within 30 minutes after taking the ipecac, gagging may
help. If not, give your child a second tablespoon of
ipecac.
- Nosebleed
Pinch the soft parts of the nose against the center wall
for 10 minutes. Tell your child to breathe through his
mouth during this time. If blood continues to come out
of the nose while it is pinched, you may not be pressing
on the right spot.
If the nosebleed hasn't stopped after 10 minutes, insert
a piece of gauze covered with vasoconstrictor nose drops
(for example, Neosynephrine) or petroleum jelly into the
nostril. Squeeze again for 10 minutes.
If bleeding persists, call your child's physician but
continue applying pressure in the meantime.
- Skin injuries
Call your child's physician immediately if you have any
difficulty stopping the bleeding, if the wound is caused
by a dirty object, if there is any chance that a foreign
body is in the wound, or if the skin is split and will
need stitches. Any deep cut that needs stitches must be
sutured within 12 hours. After 12 hours the wound is no
longer clean enough to close with stitches.
- Abrasions or superficial cuts
Wash abrasions or superficial cuts for 5 minutes with
soap and water; then rinse well. If the area of the
cut may get dirty (for example, the hand), put on an
antibiotic ointment and Band-Aid or sterile gauze
dressing and change it daily.
- Puncture wounds (as from stepping on a nail)
Soak the area in hot water and soap for 15 minutes.
Try to make the puncture wound bleed some more. If
there is any chance that an object has broken off
inside the puncture wound or if your child has not
had a tetanus booster in the last 5 years, call your
child's physician.
- Blood blisters
Do not open blood blisters. Opening them does not
help them heal and increases the possibility of
infection. They will peel off and be replaced by new
skin in about 2 weeks.
- Bruises
Put ice on the bruise for 20 to 30 minutes. No other
treatment should be necessary.
- Slivers and splinters
Most slivers can be removed with a needle and
tweezers. Before you use them, sterilize the needle
and tweezers with alcohol. Wash the skin surrounding
the sliver with soap before you try to remove the
sliver. Grasp the sliver firmly with tweezers and
pull it out at the same angle it went in. Call your
child's physician if you can't remove a sliver.
- Head injuries
- Observation and rest
Observe your child for the first 2 hours after the
injury. Encourage your child to lie down and rest
until he no longer has symptoms. It is all right for
your child to sleep; trying to keep him awake
continuously is unnecessary. Have your child sleep
near you so you can periodically check on him.
- Diet
Give your child only clear fluids (ones you can see
through) and no food until he has gone 6 hours
without vomiting. Vomiting is common after head
injuries.
- Avoid pain medicines
Don't give your child acetaminophen, aspirin, or
ibuprofen because your physician needs to know your
child's reaction to the injury. If your child's head
hurts badly enough to need a pain reliever, your
physician should check him.
- Special precautions and awakening
Although your child is probably fine, watching him
for 48 hours will ensure that you don't miss any
serious complication. After 48 hours, however,
your child should return to a normal routine and full
activity.
- Awaken your child twice during the night: once at
your bedtime and once 4 hours later. (Awakening
him every hour is unnecessary and next to
impossible.) Arouse him until he is walking and
talking normally. Do this for 2 nights. If his
breathing becomes abnormal or his sleep is
otherwise unusual, awaken him to be sure a coma is
not developing. If you can't awaken your child,
call your child's physician immediately.
- Checking pupils is unnecessary. Some physicians
may ask you to check your child's pupils (the
black centers of the eyes) to make sure they are
equal in size and become smaller when you shine a
flashlight on them. Unequal pupils are never seen
before other symptoms like confusion and unsteady
walking. In general, pupil checks are necessary
only for a hospitalized child with a severe head
injury.
CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:
- Your child is not acting normal.
- Your child's condition becomes worse in any way.
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Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
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Copyright 1999 Clinical Reference Systems
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