EMERGENCIES.

HEMORRHAGES.

Hemorrhage from the arteries may be recognized by its bright red color and by the spurting jets by which the blood leaves the wound. Venous (from the veins) hemorrhages flow in a steady stream and are darker in color. Arterial hemorrhage may be checked by firm pressure over the side nearest the heart or above the wound. Venous hemorrhages may be checked by firm pressure on the side distant from the heart or below the wound. Large veins like the jugular should be compressed both above and below the wound because the vein may bleed from both ends. If possible, digital pressure should be made directly over the bleeding point.

Hemorrhage from the leg may be checked by firm pressure upon the femoral artery, in the middle of the groin at the top of the thigh.

Hemorrhage from the forearm by compression under the inner edge of the biceps against the humerus.

Hemorrhage from the upper arm by compression of the axillary artery against the humerus in the axilla.

Hemorrhage from the cheek by compression on the facial artery against the lower jaw just in front of the masseter muscle.

Flexing the limbs at the joints with a pad between them to make the compression secure and then binding the part may prove a successful method of arresting the flow of blood. A constrictor of rubber tubing twisted firmly around the limb is a ready appliance and a most successful way of checking a flow of blood from an injured limb. But it should not remain on longer than absolutely necessary or gangrene may result from complete stoppage of the circulation.

Wounds should be packed fully and evenly with some absorbent material. Applications of heat and cold are common methods of checking hemorrhages, heat being at all times preferable. Hot water poured on open wounds will encourage coagulation. Bleeding from an ulcer of the leg, which often results from varicose veins, should be stopped by firm pressure over the wound.

Hemorrhage from the Lungs.—A teaspoonful of salt taken internally may stop it. Place an ice-bag over the chest. Morphin, gr. ⅛-¼, may be given under the instructions of a physician. In all cases put patient in bed and enjoin complete rest until medical aid arrives.

Nose-bleed (Epistaxis).—First of all, position and rest should be attended to. The patient should not lie down unless very weak. The higher the head the better. Loosen clothing about the neck and thorax. Caution patient against coughing or sneezing. Holding the nostril tightly closed, with cold applications to the back of the neck, is sometimes successful. Insufflation of ice- or alum-water, or of tannic acid solution may induce coagulation. Profuse bleeding will require packing of the nostrils.

FRACTURES.

Compound Open Fracture.—The bone is broken and the wound extends from the seat of the fracture to the outside. Such wound may be caused by the injury itself, or may occur secondarily from the protrusion of pieces of bone through the skin.

A comminuted fracture is one in which the bone is broken into a number of fragments.

An Impacted Fracture.—The broken ends have been forcibly driven into one another, and are thus fixed.

Multiple Fracture.—The bone is fractured at different points, or when different adjoining bones are broken.

A complicated fracture is one associated with a serious injury to some important adjacent part—e.g., a large vessel.

A green stick or incomplete fracture occurs where the bone is soft and bends, and is only partially fractured; it is most frequent in children.

Symptoms of fractures are usually pain, loss of function, deformity (seen or felt by passing the fingers over the seat of pain), crepitus or the grating sound produced and felt on rubbing the broken ends against each other, abnormal mobility in the course of the bone, swelling, and discoloration.

The principal point is to keep the part immovable and in a position to give as little pain as possible. Support the limb with something stiff and padded with cotton or remnants of yielding material. Bandages can be made of handkerchiefs, strips of linen, ribbon, etc., to keep the splint firm.

For the forearm padded splints long enough to take in the hand from above the elbow should be applied. Tie firmly with bandages and suspend in a sling.

If the upper arm be fractured, bind it tightly to the side. For the thigh, the splints should extend from under the arm to the ankle and should be bound to the body and leg with long towels or sheets torn into strips. A splint made of blankets, rolled up tightly from both sides on broomsticks, allowing space for the limb to rest between the supports, is a good and ready appliance. Always make extension to prevent contractions of the muscles, as this would result in shortening the leg.

For a broken clavicle (collar-bone) bind the arm to the chest. Put the patient on the flat of his back with a small pad between the shoulder-blades. This will keep the broken ends in a normal position.

N. B.—In every case elevate and support the injured member on a pillow, keep in position and give complete rest until medical aid arrives.

DISLOCATIONS.

Dislocation is a displacement of the joint. It may occur with a break of the limb, but usually results from a fall or strain.

There may be deformity and inability to move the injured part. Sometimes an abnormal projection is the first sign. If inflammation arises, apply cold applications. The only treatment a nurse may give is to keep the patient quiet and await skilled help.

SPRAINS.

There may be extreme pain, swelling, inflammation, discoloration, and inability to use the joint. Support and elevation of the limb is of the greatest importance. Use hot or cold applications to allay the inflammation and pain. Cover with a thin soft pad, and bandage evenly and firmly. A sprain should not be neglected, as it may cause future disease of the injured part.

For recent bruises cold applications are best. Give the patient complete rest, support and elevate the injured limb, apply cold or hot applications, and await skilled help.

BURNS AND SCALDS.

In severe cases the constitutional treatment is of more importance than the application of local remedies. If the patient is in shock wrap him in warm blankets, and give him stimulants. In superficial cases where the skin is not broken powder with bicarbonate of soda (baking soda). A ready domestic application is sweet oil. Exclude the air at all times. When vesicles have been produced they should be punctured with a sharp instrument, and the serum gently evacuated with absorbent cotton. Apply soothing ointments or wet dressings. In case of severe burns of the body immerse the patient in a warm bath, keeping it at even temperature. Separating a layer of common white cotton wadding, and wrapping it about the injured part will allay the pain, and the cotton has the advantage of not adhering to the raw surface. Splints and bandages should be employed to prevent contractions.

BURNS OF THE EYE.

For burns resulting from molten lead, strong alkalies, lime, or acids, flush freely with warm water or boric-acid solution, and anoint with pure vaselin or a few drops of castor oil. Do not rub the injured tissues. The applications should be made quickly and very gently. Put on cold compresses until medical aid arrives.

INJURIES TO THE EYE.

For surface injuries a drop of castor oil may be applied, and the eye kept closed for the day with a pad of wadding and a bandage.

SYNCOPE (FAINTING OR SWOONING).

Place the patient in a recumbent position. Loosen all clothing, and dash cold water on the face and chest. Spirits of ammonia or smelling salts should be used with caution, and not brought too near the nostrils. The pulse and general appearance will indicate if condition is serious. Give whisky and strychnin sulphate (¹/₃₀ gr.) hypodermically if necessary.

HYSTERIA.

In hysteria the patient may be apparently unconscious; the body is normal to the touch, the pulse is full and regular, the color is natural, and if an attempt is made to raise the eyelid it will be met with resistance. Do not leave the patient alone, but do not disturb her until she recovers.

EPILEPSY.

The attack comes on very suddenly. The patient utters a sharp cry, and falls to the ground. The muscles are rigid, the eyes staring, and there may be frothing at the mouth. The muscles soon relax, and there are twitchings of the whole body. The attack may last only a few minutes. Place the patient on his back with the head slightly elevated, and loosen all clothing. Put a wedge between the teeth, give him plenty of fresh air, and do not attempt to stop the movements.

DROWNING.

Begin artificial respiration at once, then soon as possible remove or loosen all clothing about the back, chest, and abdomen. Free the throat and mouth from mucus and foreign substances. Secure the tongue with a dry cloth or handkerchief; keep it drawn forward and to one side, as this opens the windpipe. Then turn the patient face downward, allowing the abdomen to rest on a roll of goods. Make firm pressure on the back and on both sides of the thorax to evacuate the lungs. Envelop the body in warm blankets, apply heat to the feet, and stimulate with hypodermic of strychnin, whisky, and coffee.

SUSPENDED ANIMATION FROM NOXIOUS GASES.

Remove patient at once into the fresh air. Employ artificial respiration, apply heat, and stimulate hypodermically.

METHODS OF ARTIFICIAL RESPIRATION.

Sylvester’s Method.—Lay the patient upon his back; kneel above the head, take firm hold of the arms above the elbow, and move them horizontally—first away from the body, then over the head until the hands touch behind; pull them backward for a few seconds. This process expands the chest cavity, and the lungs are filled with air, inducing inspiration. Return the arms to the first position, and make strong pressure on the sides of the chest and epigastrium to expel the air and effect expiration. Movements should not be too rapid; they should be repeated about sixteen times a minute. In case of apparent want of success, persist in the treatment until it has been ascertained that the heart has ceased to beat.

Marshall Hall’s Method.—Roll the patient over on his breast, make gentle pressure on the back, then turn the body gently but completely on the side, and again make gentle pressure on the back. Repeat these movements fifteen times every minute.

Artificial respiration may be kept up for hours before the faintest symptoms of life are shown.

SUNSTROKE.

Two conditions result from exposure to excessive heat: thermic fever and heat exhaustion.

In thermic fever, after prodromal symptoms consisting of headache, nausea, and vomiting, there are stupor or coma, fever ranging from 105° to 110° F., flushing of the face, contraction of the pupils, a rapid, full pulse, and noisy respirations.

Management.—Pack the patient in ice, and rub with ice. Ice-water enemas may also be given. Bleeding and the subcutaneous administration of normal salt solution are sometimes efficacious.

In heat exhaustion consciousness is not lost; the skin is cold and moist; the respirations are shallow and rapid, but not noisy; and the pulse is feeble.

Management.—The patient should be covered with blankets and surrounded with hot bottles. Aromatic spirit of ammonia (30 minims), whisky, and black coffee are useful stimulants.