Tuesday, June 12, 2018

Emergency and First Aid then and Now


WARNING GRAPHIC PHOTOS



Emergencies and First Care:
I have chosen some emergencies that might come up in some of your stories-historically or current. I hope a bit of this helps-for the sake of time I abbreviated each to a few sentences. No Matter what the injury, do not forget to check in contemporary stories to--Check A, B, C’s—Airway, breathing and circulation first. For the correct steps to CPR, take a look at the American Heart Association website for examples. Or take an official Healthcare Provider CPR course which costs around $60.00 and it will go into great detail about what is done in a lot of situations from heart attack to stroke. This type of course is for Healthcare providers of course but even the simpler courses with entities like Red Cross can be very beneficial in saving lives. RN’s most often complete a course in ACLS-Advanced Cardiac Life Support, which is an intensive course on reading heart rhythms and treating or shocking as necessary. Now, none of this existed in our historical stories so no one will be trying CPR for the most part.


SHOCK---Call 9-1-1. Lay the Person Down. Elevate the person's feet about 12 inches unless head, neck, or back is injured or you suspect broken hip or leg bones. Shock, which may cause any of the following symptoms: Confusion, Clammy Skin, Dizziness, Low blood pressure, Paleness, Rapid pulse, Shortness of breath Call 911.
Historically, most physicians knew to lay a person down and keep them warm.

ALLERGIC REACTIONS: Difficulty breathing-wheezing-tightness in the throat-hoarseness-trouble Speaking-swollen lips, tongue, or throat-Nausea, abdominal pain, or vomiting-Fast heartbeat or pulse-anxiety or dizziness-Loss of consciousness. This very serious condition was probably not corrected historically and it was a gamble whether or not the patient would live or not.
 
ANAPHYLAXIS-A medical crisis that can end in death if not reversed. (Same as Allergic reaction though this severe reaction often ends in death even today.

ANIMAL BITES: (Mammals) Stop Bleeding. Clean and Protect. Get medical help immediately for any animal bite that is more than a superficial scratch or if the animal was a wild animal or stray, regardless of the severity of the injury. Rabies can be an issue but historically that was called Hydrophobia as those afflicted seemed to have a fear of water and succumbed to a very horrible death.

ASTHMA ATTACKS: Symptoms of acute attack include difficulty talking or walking because of shortness of breath or lips or fingernails turning blue. Sit the person upright, loosen tight clothing. If the person has asthma medication, such as an inhaler, assist in using it. Monitor the Person Until Help Arrives.

Inhaler to open airway-Historically herbs were used and even chloroform to relax the bronchioles.

FRACTURES AND DISLOCATONS-Stop Bleeding if skin is broken as in a open fracture. Splint the Area. Reduce Swelling. Apply ice pack/elevate. Call (9-1-1) RICE-Rest, ICE, Compress (Wrap) and Elevate.

Protrusion of a fractured rib. Today a patient may be given a support binder but historically the patients were wrapped tight which the doctors of that day and time didn't know caused pneumonia because the patient couldn't breathe deep to clear secretions.



Dislocated Shoulder is usually obvious and can be put back in place but is very painful for several weeks later. Old West Docs would have just held this patient down and pulled and pushed the arm back into place likely without pain medication or maybe with a big shot of whiskey.

This is a fracture of both bones in the lower arm. These bones need set. Today that might mean surgery or a conscious sedation where the bones could be manipulated back in place. Historically the Physician would have pulled hard to set the bone and hope for the best in healing which may do well or may have left a deformity and lack of usefulness to the limb. No one back them worried of nerve damage in fractures and there were times full loss of mobility of a limb happened.



VEHICLE ACCIDENTS-Spinal & Head InjuriesShock, concussion, fractures…Head and Spinal injuries: Cervical fx: 3,4,5 the patient will need airway support. Cervical fx: 5 through back no trouble breathing, but the level of injury tells what the patient is able to move or do. Writer Tips:Remember spinal injuries can result in permanent paralysis. Head injuries can take months to heal and often change a person personality. (Not an issue prior to vehicles, but wagon accidents, falls from animals or buildings could have happened historically resulting in trauma that needed treatment.





COLLAPSED LUNGS--Broken ribs—would be wrapped tightly in historical times but these days it’s best to let the patient be able to take deeper breaths or pneumonia can happen. A word about chest tubes-used to remove fluid, blood or air from the lining around the lungs. This is to allow the lungs to re-inflate. For historicals most likely the patient would have been on bedrest and had a difficult time breathing and many would have died.


This modern patient likely suffered a trauma from the look of the bruises on the chest and the result was a collapsed lung on the left side. The chest tub in inserted and stitched into place to allow the draining of blood or air so the lung can refill. Again historically this was a very grave condition.

FALLS-- result in a few things: Back, Pelvic and leg fractures-often open (Bones sticking out). The biggest thing in a bad fall is aortic dissection (rupture of the aortic artery-usually lethal) & Head or Neck injuries. Blunt force trauma can rupture the spleen etc. Falls in historical times just meant hauling the injured person to bed and nursing them from there and often times death was the result from unknown bleeding  and later infection.

FIGHTS- Broken hand and fingers-boxer fracture. Broken noses, black eyes, cuts and bruises. Broken ribs, jaws, head injuries. Treatment for breaks and bruises--RICE-Rest, Ice, Compress, Elevate, Pain Meds. Historically it was known that ice decreased pain and swelling.

FIRST DEGREE BURNS: First layer of skin-blister or surface burn. Stop Burning Immediately. Medicate.

SECOND DEGREE BURNS: Into the second layer of skin. Cool Burn. Immerse in cool water for 10 or 15 minutes. Protect Burn. Prevent Shock.

THIRD DEGREE BURNS: Call 911-Into the Muscle and to the bones the burn is so deep. Protect the Burn. Separate burned toes and fingers with dry, sterile dressings. Do not soak burn in water or apply ointments or butter, which can cause infection. Prevent Shock.


Severe burns today can end in death due to closing of the airway and loss of tissue fluids. Sometimes patient do well the first 24 hours and then die later of organ failure from the trauma. Historically, burn victims might take days to die but there was little done for them but to try to clean and keep clean bandages in place. Infection is an issue now and in the old days.

CONCUSION: Anyone with a suspected concussion should be seen by a doctor. Nausea, dizziness, memory loss, headache, confusion concentration problems, issues with light or sound, irritable, aggressive, anxious, insomnia, vomiting. Symptoms will likely improve in 7 to 10 days. Historically, physicians could do very little to know if there was a bleed inside the brain. Cold therapy is done today and the value of  ice was known in history as well. A concussion is basically the brain sloshing around in the head and causing swelling and injury, sometimes mild and sometimes enough to cause a bleed in various areas of the brain.





FROSTBITE--Do not use direct heat from heating pads, radiator, or fires. Do not rub or massage the skin or break blisters. Bandage the Area: Loosely apply dry, sterile dressings. Put gauze or clean cotton balls between fingers or toes to keep them separated. SEEK MEDICAL HELP! Historically it was thought that rubbing the limbs helped but today we know if can casue more damage.

HEAT STROKE--Call 911. Heat stroke is a medical emergency. Seek immediate emergency care. Lower Body Temperature Quickly While Waiting for Emergency Services to Arrive. Get the person into air conditioning, out of the sun, Spray with cool water, or ice packs to the armpits, neck, and groin. Fan air across the person to increase cooling. Might respond and be able to drink.

HEAT EXHAUSTION-Severe reaction to the heat-call 911! Will be less likely to respond.


For heat injury in historical times fluids or ice would have been used to help but either one of these can be very deadly even today.
 
POISONING-Call 911 if the person: Has collapsed, Has stopped breathing or is having trouble breathing, Is having seizures or convulsions, Is unconscious or not alert. Call Poison Control if: Call the poison control center (9-1-1 operators will connect you) if the person has done any of these things and is alert: Swallowed too much medicine or the wrong kind, Inhaled poison, Gotten poison on the skin or in the eye, Swallowed a household product or other chemical.

SEIZURES- need emergency care unless you know the person has a history of seizures and can be treated for a brief seizure at home. Prevent Choking, Loosen clothing around the person's neck, Roll the person on his or her side to keep the airway open, Don't put anything into the person's mouth. Protect From Injury: Move sharp objects, such as glassware or furniture, away from the person. Ask bystanders to give the person room. Do not restrain or hold down the person. Stay with the person until emergency help arrives.

SMOKE INHALTION-Call 9-1-1 if: Is unconscious, Is dizzy or confused, Has chest pain-tightness, Is coughing-choking violently, Has wheezing-shortness of breath, Has ash or smoke around mouth and nose, Has burns inside mouth, throat, and nose, Has swollen airways, Has black or gray saliva, Is nauseated or vomiting, Is hoarse, Has double or blurry vision, Has numbness or tingling in his or her extremities. Damage from toxin inhalation may not show up for hours and can worsen quickly.
Smoke damage to Trachea.




Sometimes it isn't the fire that kills a person, it can be the smoke. Initially a smoke inhalation victim might they are fine only to have their airway close off later on. These patient need quick ventilation and a tube to keep their airway open. Historically, many of those involved in fire died right away or suffered death in the first few days.


SNAKEBITE--Move the person beyond striking distance of the snake. Have the person lie down with wound below the heart. Keep the person still to keep venom from spreading. Cover the wound with loose, sterile bandage. Do not: Cut a bite wound or Attempt to suck out venom—unless you are writing in the old west, but do apply tourniquet, ice, or water, do not give the person alcohol or caffeinated drink.



Copperhead-Tissue Poison-Toxic (A cobra is Neuro-Toxic.)



Tissue and vessels are affected and destroyed by the snake's poison. Today Ante venom helps but often people still have horrible tissue loss and some die. Historically this might mean the loss of the limb or death. Treatment would have meant  ice and keeping the site clean and at times sucking the poison out of the wound. The issue with that is it often killed the one sucking the poison. Makes for a bad story.

GUNSHOT WOUNDS- are unpredictable puncture wounds that cause major tissue damage. Three factors work together to determine the severity of a gunshot wound. Location of the injury--Size of the projectile--Speed of the projectile. Changing the speed of the bullet makes the most difference to the amount of damage done. Basically, bigger guns make bigger holes. Surviving a gunshot wound depends greatly on how quickly a victim gets to medical help Know the type of bullets used: Jacket-shrapnel Hollow Points- Shock waves Slugs-shotgun Buck Shot-Spray.