(Continued from Part 3. This concludes the article.)
DEEP VENOUS THROMBOSIS, PULMONARY EMBOLISM, CHOKING, AND NOSE BLEEDS
Today is the last of this four-part series. I hope that the previous three parts have been informative and helpful. Our topics for today are deep venous thrombosis, pulmonary embolism, choking, and nose bleeds (epistaxis). There are also a few suggestions regarding how to make an effective emergency notebook. Before we begin, please remember to see a medical professional ASAP in an emergency! Reliance on any information provided here is solely at your own risk for use when no timely medical professional help is available. Do not, consider the following information as complete or as any attempt to advise, diagnose, treat, or manage anyone’s medical condition.
DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM (LUNG CLOT)
A deep venous thrombosis (DVT) is a blood clot that forms in the deep veins, usually of the legs. When does this occur? If someone is on prolonged bed rest, after surgery or childbirth, on birth control pills, or on a long sedentary trip, a clot may form in one or more leg veins. A friend of mine almost died as a consequence of post-operative venous thrombosis. If at risk, be on the look-out for redness, swelling, and crampy soreness of the calves. So what is the big deal? The clot(s) can break loose, travel through the heart, and lodge in the lung(s) preventing essential blood flow and life-giving oxygenation. It may even be so severe as to result in sudden death. What are the symptoms of pulmonary embolism? Sudden shortness of breath, dizziness, chest pain, and coughing of blood may occur. Best is to prevent the deep venous thrombosis from ever happening. If sedentary, take a short walk every two hours. If on a long trip, stay well hydrated by drinking water, and exercise your toes, ankles, and lower legs if not allowed to leave your seat to walk in the aisle. If this is not possible (example post-surgery or strict bed rest), wiggle your toes and flex your ankles every waking hour and then contract your calf, thigh, and buttock muscles in that order for several repetitions. Also take slow deep breaths every hour. If at high risk, your doctor may prescribe blood thinners and compression stocking, or may suggest taking aspirin. If you see the signs of DVT, seek medical help asap. Call 911 for the symptoms of pulmonary embolism.
DEEP VENOUS THROMBOSIS/PULMONARY EMBOLISM MEDICAL EMERGENCY SHEET
- TRAVEL- DRINK WATER.
BY CAR- STOP AND WALK EVERY 2 HOURS.
BY PLANE- STAND UP AND IF ALLOWED WALK UP AND DOWN THE AISLE.
IF NOT PERMITTED, SEE #2 BELOW.
- PREVENTION IF BEDFAST, POST-SURGERY, POST-ACCIDENT ETC.
HOURLY MOVE TOES, ANKLES, AND PERFORM UPWARD CONTRACTION OF MUSCLES.
TAKE SLOW DEEP BREATHS HOURLY.
WALK EVERY TWO HOURS OR MOVE TO SIT IN A CHAIR IF PERMITTED.
ASK YOUR DOCTOR IF YOU SHOULD USE COMPRESSION STOCKINGS OR ASPIRIN.
- SYMPTOMS OF DVT- EXAMINE TWICE DAILY FOR CALF REDNESS, SWELLING, CRAMPS, SORENESS.
GET MEDICAL HELP ASAP UPON SEEING THE ABOVE. DO NOT MASSAGE CALVES
- SYMPTOMS OF PULMONARY EMBOLISM (LUNG CLOT)-
CALL 911 FOR SHORTNESS OF BREATH, SUDDEN DIZZINESS, CHEST PAIN, OR COUGHING UP BLOOD
Choking is the fourth most common cause of accidental death, especially in the over 65 age group.
Just a few months ago, when I was recovering from eye surgery, I aspirated food at lunch and suddenly could not breath. My airway was *completely* occluded and it was a very scary next few minutes until the stubborn obstruction was expelled. I knew that an ambulance could never reach me in time! I highly recommend that people practice what they will do in a similar emergency and know what maneuvers to perform if they are alone when it occurs. There are anti-choking devices out on the market, but I have no experience with them and am aware that opinions vary widely as to their safety and effectiveness. Train everyone in your household to know the “I am choking” signal of hands around the neck. Ask the patient, if conscious, if they want you to help them. Wrap your arms around their waist, form a fist with one hand and wrap the other around it, then with both hands make several upward thrusting movements above the level of the navel. This will dislodge and expel the obstructing material. Do not give up. If the patient is on the floor, straddle them and perform the maneuver. After five thrusts, perform a mouth sweep with your fingers checking for foreign material. Then repeat. Consider watching an instructional video online. If the patient is pregnant, place your hands just below the breast bone. Instructions are different for a baby. See below. If you are alone, try performing thrusts with your own hands, or against an object such as a table or countertop corner. I have since practiced a few times on myself using my fists in position and then pressing myself down on a countertop. I now have a “favorite” site selected near the dinner table. Please don’t rely on a Medical Emergency Sheet for this accident. There will be no time to consult it. I do, however, include it for learning purposes in advance.
CHOKING MEDICAL EMERGENCY SHEET- MEMORIZE
- SIGNAL- HANDS AROUND NECK MEANS “I AM CHOKING.”
- ASK IF HE WANTS YOU TO HELP. GET PERMISSION, ESPCIALLY FROM A STRANGER.
HE WON’T BE ABLE TO SPEAK, BUT CAN NOD HIS HEAD.
- STAND BEHIND HIM. WRAP YOUR ARMS AROUND HIS WAIST. MAKE A FIST WITH ONE HAND AND
WRAP THE OTHER AROUND IT. MAKE 5 UPWARD THRUSTS USING YOUR HANDS ABOVE THE
LEVEL OF THE NAVEL. IF STILL CHOKING, CALL 911, THEN CONTINUE PERFORMING THE
MANEUVER. DON’T GIVE UP.
- PREGNANT PERSON- MAKE THRUSTS JUST BELOW THE BREAST BONE. IF STILL CHOKING AFTER
5 THRUSTS, CALL 911. THEN CONTINUE PERFORMING THE MANEUVER. DON’T GIVE UP.
- COLLAPSED PERSON ON THE FLOOR- PUT HIM ON HIS BACK, STRADDLE HIM FACING HIS HEAD, AND
PERFORM THE MANEUVER. AFTER SEVERAL THRUSTS, IF NO IMPROVEMENT, OPEN HIS MOUTH
AND PERFORM FINGER SWEEP TO CHECK FOR A REMOVABLE OBSTRUCTION. CALL 911.
REPEAT THE MANEUVERS UNTIL HE CAN BREATH. DON’T GIVE UP.
- INFANT- SIT DOWN, PLACE BABY FACEDOWN ON YOUR FOREARM SUPPORTING IT WITH YOUR
THIGH. GIVE 5 GENTLE BACK BLOWS.
IF NO SUCCESS- PLACE BABY FACE UP ON YOUR FOREARM WITH HIS HEAD LOWER THAN HIS
CHEST. USING 2 FINGERS IN THE CENTER OF THE BREAST BONE, MAKE 5 QUICK CHEST
COMPRESSIONS. IF NOT BREATHING, CALL 911.
CONTINUE THE ABOVE FACEDOWN-FACEUP MANEUVERS UNTIL THE BABY CAN BREATH.
One usually doesn’t think of a nosebleed as a big emergency, but it can be. A friend of mine recently had to call 911 and be taken to the emergency room for one. The incidence of nosebleeds can be reduced, but not eliminated, by adequate humidity in the environment, not picking one’s nose, sneezing through an open mouth, and not blowing one’s nose too vigorously. Keep children’s fingernails short. Allergies, blood thinners, hypertension, and trauma are other causes of epistaxis. Most bleeding nasal vessels are located anteriorly and can be managed at home; however, 10 to 20% are situated in larger vessels more posteriorly. These posterior vessels can bleed profusely requiring medical intervention. To treat a nosebleed, sit down, tip your head forward, and pinch the fleshy nostrils firmly together for 5 minutes. (If you are dizzy, drop your head between your knees, but this will unfortunately increase the pressure in the blood vessels and increase the bleeding.) If it is still bleeding after 5 minutes, pinch the nostrils shut for 10 minutes. If still bleeding, determine which nostril the blood is coming from by shutting off one nostril and then the other. Stuff a petroleum jelly coated tampon, long piece of gauze, or long thin cloth up that nostril. Leave the packing in place for at least 24 to 48 hours. This may necessitate the placement of a piece of tape across the nostril to prevent the packing from dislodging. Another option is to spray Afrin or other over the counter vasoconstrictor up the nostril, but not if you suffer from hypertension. Once the bleeding has stopped, do not bend, lift, strain, manipulate or blow the nose for a few days. In general, if the bleeding isn’t stopped after 10 minutes, or if there is an associated injury, or the loss of approximately a cup of blood, get help from a medical practitioner.
NOSEBLEED MEDICAL EMERGENCY SHEET
- SIT DOWN AND TILT HEAD SLIGHTLY FORWARD. (DO NOT PUT HEAD LOW BETWEEN KNEES UNLESS
AT RISK OF FAINTING.)
- PINCH FLESHY NOSTRILS TOGETHER FOR 5 MINUTES.
IF STILL BLEEDING AFTER 5 MINUTES, REPEAT FOR 10 MINUTES (TOTAL OF 15 MINUTES).
- IF STILL BLEEDING, DETERMINE WHICH NOSTRIL IS BLEEDING BY CLOSING ONE AT A TIME.
- CONSIDER SPRAYING AFRIN OR OTHER NASAL VASOCONSTRICTOR UP THE BLEEDING NOSTRIL
AND PINCH THE NOSTRIL SHUT FOR 5 MINUTES. IF HYPERTENSIVE DO NOT USE AFRIN OR
- IF STILL BLEEDING, INSERT PETROLEUM JELLY COATED TAMPON OR OTHER PACKING INTO NOSTRIL
AND FIX IN PLACE FOR 24 TO 48 HOURS.
- NO LIFTING, STRAINING, VIGOROUS ACTIVITY, OR RUBBING/PICKING OF NOSE FOR A FEW DAYS.
MAKING AN EMERGENCY NOTEBOOK
If you haven’t started this project yet, please allow me to offer a few suggestions. For each emergency notebook, I selected a red 3-ring binder with a clear plastic cover and dividers with large colored tabs. In the front pocket, consider placing a table of contents in large print that lists all sections and their topics. I like to also place a wide colored mark, next to each section in the table of contents, that corresponds with the color of the divider tab for that section. It allows for rapid access during times of stress. Slip a large “Emergency” label into the plastic pocket of the spine. Make whatever divisions work for your needs. In my notebook, I have sections for allergy/anaphylaxsis, bites, brain, ent (ears, nose, throat), gi (stomach, intestines), gunshot, heart, heat, neuro (neurology), orth (orthopedics such as fractures and dislocations), pain (management), and wounds. This notebook will help any member of my family. Keep yours in an easy to access and visible location perhaps even with a pair of reading glasses sitting on top of it.
I’ve also made other notebooks with printed information, some of them medical. One labeled “MED” in large letters on the spine has dividers for dental, diarrhea, gu (genitourinary), infectious disease, nutrition, sanitation, respiratory system, women’s health, etc. I have separate notebooks for common clinic visits, herbals, pediatrics, pharmaceuticals, and trauma. You can never have too much information at your fingertips, especially if it is well-organized.
May you never need to use these Medical Emergency Sheets and accompanying information, but if you do, my fervent hope is that they will help you in your time of need. – K.B., M.D.