(Continued from Part 1.)
HEART ATTACK, FRACTURE, AND HEAD INJURY
Today, we will cover these topics. The author has had an unpleasant experience with the latter two, more than once! As mentioned previously, having a prepared summary to turn to for *initial* information during a medical emergency can be helpful. Further reading of other sources can then occur after the immediate emergency if necessary. If at all possible, see a medical expert ASAP! Reliance on any information provided here is solely at your own risk. Do not, consider the following information as complete or as any attempt to advise, diagnose, treat, or manage anyone’s medical condition.
We all know at least a little about chest pain and the importance of calling 911 in the event of a heart attack. Do not delay. The more time elapses, the more cardiac muscle dies. Also review how to administer CPR. Is the pain, a heart attack or not? If it’s not your usual indigestion symptoms responsive to antacids, call 911! There are many different types of chest pain and even the experts
require EKG’s and other tests to make an accurate diagnosis. In a dire emergency without *any* chance of medical help, take an aspirin daily, use oxygen if available, and stay in bed completely for 3 days, and perform no physical exertion for 6 weeks. (Complete bed rest means no bathroom privileges.) Also note that females suffering heart attack often have an atypical presentation such as extreme fatigue, faintness, shortness of breath, and dizziness. Make sure that your family members know where this Medical Emergency Sheet is located so they can refer to it if you are in trouble. While waiting for the ambulance, have the patient rest with his back supported from behind and his knees bent if possible. Some also suggest taking 1 teaspoon of cayenne pepper in a cup of warm water. I doubt, however, that I would be able to ingest that if in severe pain and nauseated.
HEART ATTACK MEDICAL EMERGENCY SHEET
PAIN LASTING 5 MINUTES OR MORE-
SITE- CENTER OR LEFT SIDE OF CHEST, MAY RADIANT INTO SHOULDERS,
LEFT SIDE OF NECK OR JAW, OR FOCUS IN BACK, OR STOMACH
OTHER POSSIBLE SYMPTOMS-
SHORTNESS OF BREATH
PALE OR BLUE-GREY TINGED SKIN
ASAP- TAKE ONE REGULAR ASPRIN. CHEW 30 SECONDS THEN SWALLOW IT.
REST IN “W” POSITION (BACK SUPPORTED, KNEES BENT). TRY TO RELAX AND
STAY CALM. HELP IS COMING.
When you least expect it…… I was walking in the backyard one afternoon, lost my footing, tried to catch my fall using my other foot, and landed on the ground. I felt immediate severe pain in my ankle and noted that it was flopping at an unnatural angle. I had my husband hurry out with an ace wrap which I figure-eight wound tightly about the injured foot and ankle and then applied a cold pack that he had prepared. A kind neighbor rushed over with a pair of crutches, and I hobbled to our car. At the emergency room, the doctor showed me x-rays of a classic tri-malleolar (triple) fracture of the ankle. Did I believe it was my ankle? Oh nooo, I was in complete denial. I then tried to negotiate my way into having outpatient surgery! No way. The surgeon on call looked at my ankle and commented, “Hmm, not much swelling.” I refused pain meds and had an extremely miserable time until surgery was performed the next afternoon.
What did I do right and what did I do wrong? Right- I applied an ace wrap tight enough to limit swelling but not so tight as to cut off circulation. (Press the distal digit with your finger and watch for the prompt normal re-pinking of the nail bed.) An acquaintance of mine spent three days in the hospital in severe pain (despite pain meds) waiting for the swelling to diminish so that she could have her ankle fracture repaired. Ace wrap- good. Ice bag- good. Wrong- I should have sat in the back seat and elevated the injury. Wrong- I should have taken pain meds pre-operatively as suggested and not try to tough through it or save pain meds for use after surgery. I felt sooo much better post-op once the fractures were reduced and metal plate and screws were in place. Wrong- Trying to use a taller person’s crutches was very unsuccessful. I urge you to have a pair of crutches purchased in advance and adjusted to the correct height for each person in your family, if possible. It may also be helpful to have a walker and/or wheelchair stored away at home. Also give thought as to how you will maneuver into your house. Do you need a ramp pre-constructed for any stairs? My husband had to quickly construct one as my surgeon wanted me out of the hospital asap in order to reduce the risk of infection. Oh yes, we learned a lot.
The management of fractures varies greatly and depends on site and severity. Some fractures hemorrhage a lot internally, others don’t. Some are deformed, others aren’t. Some require surgery, others a simple cast. Bottom line, get help from medical professionals if at all possible. If someone is unconscious, or has a neck or back injury, be *extremely* careful. One wrong move can result in permanent paralysis. Immobilize the neck and back using braces, splints, sand bags, or whatever you’ve got. If the patient has to be moved, log roll him only. That means roll him onto the side while keeping the neck and spine absolutely in line and unchanged. This is critical. Best is definitely to wait for an ambulance to arrive! If it is a broken digit, a finger can be splinted, or a toe can be buddy strapped to the adjacent toe.
An open fracture is one in which the broken bone has pierced the unclean skin. This is bad news and needs aggressive treatment. The only hint may be a tiny tear or puncture in the overlying skin. This definitely calls for advanced help from medical professionals.
This medical emergency sheet is for use *only* if there is no hope of any help from medical professionals.
FRACTURE MEDICAL EMERGENCY SHEET
- IMMOBILIZE- ESPECIALLY IMPORTANT IF HAVING NECK OR BACK PAIN.
CALL 911 IF SPINE INJURY AND DON’T MOVE THE PATIENT.
IF YOU MUST MOVE THE PATIENT, LOG ROLL ONLY IF POSSIBLE SPINE INJURY.
USE A SPLINT FOR LIMBS OR DIGITS. BUDDY STRAP TOE TO NEIGHBORING TOE.
CAN ACE WRAP SOME SITES, BUT CHECK FOR ADEQUATE CIRCULATION DISTALLY.
- RICE- REST, ICE, COMPRESSION (ACE WRAP), AND ELEVATION ABOVE HEART LEVEL.
- TREAT FOR SHOCK- KEEP PATIENT WARM AND HYDRATED UNLESS IMMEDIATE SURGERY NEEDED.
REASSURE AND CALM THE PATIENT. HELP IS COMING. YOU’LL FEEL BETTER LATER.
CONSIDER PAIN MEDS CAREFULLY. AVOID NSAIDS WHICH CAN INCREASE BLEEDING.
(NSAIDS means non-steroidal anti-inflammatories such as aspirin, ibuprofen, etc.)
- ASSUME IT IS AN OPEN FRACTURE IF THERE IS A SKIN WOUND.
IRRIGATE THE WOUND WITH AN 18G NEEDLE ON SYRINGE. FLUSH THE LACERATION
WITH 16 OZ STERILE IV FLUID OR STERILE WATER PER HALF INCH OF WOUND.
LEAVE THE WOUND OPEN AND COVER IT WITH ANTIBIOTIC OINTMENT OR HONEY + GAUZE
REPEAT STERILE IRRIGATION ONCE OR TWICE DAILY.
START ORAL ANTIBIOTICS.
- READ SOURCES FOR FURTHER GUIDANCE ABOUT CARE OF FRACTURE TYPE AND PAIN CONTROL.
I’ve certainly been there, done that, and have the T-shirt for four head traumas. Oh yes, by all means get professional medical care. My latest occurrence was during the feeding of farm animals. I slipped and fell, hitting my head not once, but twice, on rigid two by fours and landing my lacerated head in a nice pile of manure. I called my husband who arrived quickly, helped me up, and noted that I had already bled down to the level of my waist. I never lost consciousness but felt a little weak while being walked into the house. Care consisted by liberally rinsing my head and injured scalp with extremely cold water under the kitchen faucet for several minutes. Using two mirrors I could see that my scalp had two long but shallow lacerations that did not need suturing and I could not palpate any depressed fracture. I then sat and rested a few minutes. Next I performed a careful neurological exam on myself. Yes, I’m stubborn and maybe should have gone to a walk-in medical clinic. Frankly, doctors can make terrible patients and the old maxim states that a doctor who treats himself has a fool for a doctor and a fool for a patient.
Below is the sheet for this section. Read it if there is no medical help at all available. Consider having for quick reference a neurological exam protocol from the survival medical book of your choice for when there is no medical help available.
HEAD INJURY/CONCUSSION MEDICAL EMERGENCY SHEET
- WAS CONSCIOUSNESS LOST? IF YES, FOR HOW LONG? ALERT AND ORIENTED TIMES THREE?
(Check that the person knows who they are, where they are, and day of the week.(Orientedx3)
Do they remember what happened? If not, how close to the time of injury do they remember?
What do they remember since the accident?)
- IF TAKING BLOOD THINNERS, THERE IS AN INCREASED DANGER OF INTRACRANIAL HEMORRHAGE.
- CHECK FOR UNEQUAL SIZED PUPILS, BRUISING AROUND THE EYES, BLEEDING FROM EAR OR NOSE,
DEPRESSED SKULL FRACTURE, OR OTHER INJURIES BESIDES THE HEAD WOUND.
- CLEAN THE WOUNDS. (SEE WOUNDS SHEET PART 3) SCALP LACERATIONS BLEED HEAVILY.
- DO NOT GIVE ASPIRIN, IBUPROFEN, NSAIDS, OR ANY BLOOD THINNERS. OFFER TYLENOL ONLY.
- PERFORM A NEUROLOGICAL ASSESSMENT. REPEAT EVALUATION A FEW HOURS LATER AND A FEW
DAYS LATER. THE SEVERITY OF THE INJURY MAY NOT BE IMMEDIATELY OBVIOUS.
- HAVE THE PATIENT SIT UP AND KEEP THE HEAD ELEVATED TO DECREASE BRAIN SWELLING IF HE HAS
SYMPTOMS OR SIGNS OF CONCUSSION SUCH AS HEADACHE, NAUSEA/VOMITING, SENSITIVITY TO
LIGHT/SOUND, CONFUSION, SLOWED SPEECH/MOVEMENT, DIZZINESS, CHANGE IN
VISION/EMOTIONS/PERSONALITY, FORGETFULNESS, ETC.
- IF CONCUSSED, HAVE THE PATIENT STAY IN A DARK, QUIET ROOM. NO MUSIC, TV, TELEPHONE OR
CONVERSATION EXCEPT FOR ABOUT 30 MINUTES PER DAY UNTIL RECOVERED. SLOWLY
INCREASE ACTIVITY LEVEL AS TOLERATED WITHOUT SETBACK IN SYMPTOMS.
- MAKE SURE THAT YOU CAN AROUSE THE PATIENT EVERY 2 HOURS DURING SLEEP THE FIRST NIGHT
AND THAT THE SYMPTOMS DON’T WORSEN.
- READ MORE ABOUT HEAD INJURIES AND REMEMBER TO REASSESS THE PATIENT.
Tomorrow, in Part 3, we will cover stroke, heat exhaustion, heat stroke, and wounds.