|
Post by EPD SONAR on Jul 1, 2008 17:31:46 GMT 8
Bruise:
A bruise forms when a blow breaks small blood vessels near your skin's surface, allowing a small amount of blood to leak out into the tissues under your skin. The trapped blood appears as a black-and-blue mark. Sometimes, there also are tiny red dots or red splotches.
If your skin isn't broken, you don't need a bandage. You can, however, enhance bruise healing with these simple techniques:
Elevate the injured area. Apply ice or a cold pack several times a day for a day or two after the injury. Rest the bruised area, if possible. Consider acetaminophen (Tylenol, others) for pain relief.
See your doctor if:
You have unusually large or painful bruises — particularly if your bruises seem to develop for no known reasons. You bruise easily and you're experiencing abnormal bleeding elsewhere, such as from your nose or gums, or you notice blood in your eyes, your stool or your urine. You have no history of bruising, but suddenly experience bruises.
These signs and symptoms may indicate a more serious problem, such as a blood-clotting problem or blood-related disease. Bruises accompanied by persistent pain or headache also may indicate a more serious underlying illness and require medical attention.
Foreign object in the skin:
If a foreign object is projecting from your skin:
Wash your hands and clean the area well with soap and water. Use tweezers to remove splinters of wood or fiberglass, small pieces of glass or other foreign objects. If the object is completely embedded in your skin:
Wash your hands and clean the area well with soap and water. Sterilize a clean, sharp needle by wiping it with rubbing alcohol. If rubbing alcohol isn't available, clean the needle with soap and water. Use the needle to break the skin over the object and gently lift the tip of the object out. Use tweezers to remove the object. A magnifying glass may help you see the object better. Wash and pat-dry the area. Follow by applying antibiotic ointment. Seek medical help if the particle doesn't come out easily or is close to your eye.
|
|
|
Post by EPD SONAR on Jul 1, 2008 17:39:08 GMT 8
If you've experienced a snakebite:
Remain calm Don't try to capture the snake Immobilize the bitten arm or leg and try to stay as quiet as possible Remove jewelry, because swelling tends to progress rapidly Apply a loose splint to reduce movement of the affected area, but make sure it is loose enough that it won't restrict blood flow Don't use a tourniquet or apply ice Don't cut the wound or attempt to remove the venom Seek medical attention as soon as possible, especially if the bitten area changes color, begins to swell or is painful.
Cuts and scrapes: First aid
Minor cuts and scrapes usually don't require a trip to the emergency room. Yet proper care is essential to avoid infection or other complications. These guidelines can help you care for simple wounds:
Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don't, apply gentle pressure with a clean cloth or bandage. Hold the pressure continuously for 20 to 30 minutes. Don't keep checking to see if the bleeding has stopped because this may damage or dislodge the fresh clot that's forming and cause bleeding to resume. If the blood spurts or continues to flow after continuous pressure, seek medical assistance.
Clean the wound. Rinse out the wound with clear water. Soap can irritate the wound, so try to keep it out of the actual wound. If dirt or debris remains in the wound after washing, use tweezers cleaned with alcohol to remove the particles. If debris remains embedded in the wound after cleaning, see your doctor. Thorough wound cleaning reduces the risk of infection and tetanus. To clean the area around the wound, use soap and a washcloth. There's no need to use hydrogen peroxide, iodine or an iodine-containing cleanser.
Apply an antibiotic. After you clean the wound, apply a thin layer of an antibiotic cream or ointment such as Neosporin or Polysporin to help keep the surface moist. The products don't make the wound heal faster, but they can discourage infection and allow your body's healing process to close the wound more efficiently. Certain ingredients in some ointments can cause a mild rash in some people. If a rash appears, stop using the ointment.
Cover the wound. Bandages can help keep the wound clean and keep harmful bacteria out. After the wound has healed enough to make infection unlikely, exposure to the air will speed wound healing.
Heat Exhaustion
eat exhaustion is a non–life-threatening clinical syndrome of weakness, malaise, nausea, syncope, and other nonspecific symptoms caused by heat exposure. Thermoregulation is not impaired.
Heat exhaustion is caused by water and electrolyte imbalance due to heat exposure, with or without exertion.
Symptoms are often vague, and patients may not realize that heat is the cause. Symptoms may include weakness, dizziness, headache, nausea, and sometimes vomiting. Syncope due to standing for long periods in the heat (heat syncope) is common and may mimic cardiovascular disorders. On examination, patients appear tired and are usually sweaty and tachycardic. Mental status is typically normal, unlike in heatstroke. Temperature is usually normal and, when elevated, does not exceed 40° C.
Treatment involves removing patients to a cool environment, having them lie flat, and giving IV fluid and electrolyte replacement therapy, typically using 0.9% saline solution; oral rehydration does not provide sufficient electrolytes. Rate and volume of rehydration are guided by age, underlying disorders, and clinical response. Replacement of 1 to 2 L at 500 mL/h is often adequate.
External cooling measures (see Heat Illness: Prognosis and Treatment) are not required. Rarely, severe heat exhaustion after hard work may be complicated by rhabdomyolysis, myoglobinuria, acute renal failure, and disseminated intravascular coagulation.
Heat Cramps
Heat cramps are exertion-induced contractions that occur during or after exertion in the heat.
Although exertion may induce cramps during cool weather, such cramps are not heat related and probably reflect lack of fitness. In contrast, heat cramps can occur in physically fit people who sweat profusely and replace lost water but not salt, thereby causing hyponatremia. Heat cramps are common among manual laborers (eg, engine room personnel, steel workers, miners), basic military trainees, and athletes.
Cramping is abrupt, usually occurring in muscles of the extremities. Severe pain and carpopedal spasm may incapacitate the hands and feet. Temperature is normal, and other findings are unremarkable. The cramp usually lasts minutes to hours.
Cramps may be relieved immediately by firm passive stretching of the involved muscle (eg, plantar dorsiflexion for a calf cramp). Fluids and electrolytes should be replenished orally (1 L water containing 10 g [2 level tsp] salt) or IV (1 L 0.9% saline solution). Adequate conditioning, acclimatization, and appropriate management of salt balance help prevent cramps.
HeatStroke
Heatstroke is hyperthermia accompanied by a systemic inflammatory response causing multiple organ dysfunction and often death. Symptoms include temperature > 40° C and altered mental status; sweating is often absent. Diagnosis is clinical. Treatment is rapid external cooling, IV fluid resuscitation, and support as needed for organ failure.
Heatstroke occurs when thermoregulatory mechanisms do not function and core temperature increases substantially. Inflammatory cytokines are activated, and multiple organ failure may develop. Endotoxin from GI flora also may play a role. Organ failure may occur in the CNS, skeletal muscle (rhabdomyolysis), liver, kidneys, lungs (acute respiratory distress syndrome), and heart. The coagulation cascade is activated, sometimes causing disseminated intravascular coagulation. Hyperkalemia and hypoglycemia may occur.
There are 2 variants: classic and exertional. Classic heatstroke takes 2 to 3 days of exposure to develop. It occurs during summer heat waves, typically in older, sedentary people with no air-conditioning and often with limited access to fluids. Classic heatstroke caused the large number of deaths in Europe during the exceptionally hot summer of 2003.
Exertional heatstroke occurs abruptly in healthy active people (eg, athletes, military recruits, factory workers). Intense exertion in a hot environment causes a sudden massive heat load that the body cannot modulate. Rhabdomyolysis is common; renal failure and coagulopathy are somewhat more likely and severe.
Symptoms and Signs
Global CNS dysfunction is the hallmark, ranging from confusion to delirium, seizures, and coma. Tachycardia, even when the patient is supine, and tachypnea are common. In classic heatstroke, the skin is hot and dry. In exertional heatstroke, sweating is relatively common. In both, temperature is > 40° C and may be > 46° C.
Prognosis and Treatment
Mortality rate is significant but varies markedly with age, underlying disorders, maximum temperature, and, most importantly, duration of hyperthermia and promptness of cooling.
The importance of rapid recognition and effective, aggressive cooling cannot be overemphasized. Cooling methods that do not cause shivering or cutaneous vasoconstriction are preferred, although ice-soaked towels and ice water immersion are effective. Evaporative cooling is comfortable and convenient and considered the most rapid method by some experts. During the process, patients are continually wetted with water, and the skin is fanned and vigorously massaged to promote blood flow. A spray hose and larger fans are best and may be used for large groups of people in the field. Comfortable, tepid (eg, 30× C) water is adequate because evaporation causes cooling; cold or ice water is not needed. Cool water immersion in a pond or stream can also be used in the field. Ice packs applied to the axillae and groin can be used but not as the sole cooling method. In life-threatening cases, literally packing a patient in ice, with close monitoring, has been advocated to rapidly reduce core temperature.
|
|
|
Post by EPD SONAR on Jul 1, 2008 17:44:57 GMT 8
Eye Injuries
Subconjunctival Hemorrhage
A blood vessel on the conjunctiva (the thin layer of tissue that covers most of the eye's surface) may break, causing a solid red patch of blood on the white of the eye. Sometimes the whole white of the eye appears red. The blood lies under the conjunctiva (subconjunctival hemorrhage) and is superficial. Therefore, although the blood may look alarming, it is minor and resolves without treatment. The red area may become slightly green and then yellow within a few days. All traces of the blood typically disappear within 1 to 2 weeks. A subconjunctival hemorrhage often occurs together with a black eye.
Hyphema
A hyphema (anterior chamber hemorrhage) is bleeding into the front chamber (the fluid-filled space between the clear cornea and the colored iris; see Biology of the Eyes:Structure and FunctionFigures) of the eye. Additional bleeding may occur up to several days after the injury. A hyphema may result in permanent, partial, or complete loss of vision. Vision loss may be caused by increased pressure within the eye (glaucoma), by blood staining the cornea, or both.
People with hyphema often have blurred vision and pain when exposed to bright light. If the hyphema is large enough, a layer of blood is visible behind the lower part of the cornea when the person is upright. However, the layer may be so small that it can be seen only with magnification.
Treatment
A person with a hyphema should be examined by an ophthalmologist (a medical doctor who specializes in eye disorders) as soon as possible. Treatment usually involves bed rest with the head of the bed elevated to encourage the blood to settle. Eye drops are given to dilate the pupil (such as atropine) and to reduce inflammation within the eye (usually corticosteroids). A protective shield (either a commercial product or the bottom part of a paper cup) is taped over the eye to prevent further injury. Pressure within the eye is measured at least once daily for the first few days. If the pressure is elevated, the ophthalmologist may give eye drops such as those used to treat acute glaucoma. AspirinSome Trade Names ECOTRIN ASPERGUM and other nonsteroidal anti-inflammatory drugs (NSAIDs), which can predispose to bleeding, should be avoided for several weeks. Because a hyphema increases the life-long risk of developing glaucoma, people who have had a hyphema should have their eyes examined every year.
Retinal Detachment
Blunt injury may cause part of the retina or the entire retina to tear or to separate (detach) from its underlying surface at the back of the eyeball (see Retinal Disorders: Detachment of the Retina). Usually, only part of the retina is detached (often the outside, or peripheral, part of the retina), but if treatment does not occur soon, more of the retina can detach.
Initially, retinal detachment may create images of irregular dark floating shapes (floaters) or flashes of light. Parts of vision may be blurred or lost, usually side (peripheral) vision. If more of the retina detaches, more vision is blurred or lost.
A person with these symptoms needs to see a doctor as soon as possible. The diagnosis is made by an ophthalmologist, who examines the back of the eye with a bright light (ophthalmoscopy) after the eye has been dilated. Sometimes an ultrasound is performed. An ophthalmologist can sometimes reattach a detached retina or prevent the injury from worsening by using various treatments such as surgery, lasers, or freezing therapy (cryopexy).
Other Blunt Injuries to the Eyeball
Other injuries that can occur after a blunt force include bleeding in the back section of the eye (vitreous hemorrhage), tearing of the iris, and displacement (dislocation) of the lens. Usually, the force required to cause these injuries is high. Affected people tend to have obvious, severe eye injuries with many abnormalities. All affected people have impaired vision. Examination by an ophthalmologist and treatment should occur as soon as possible.
|
|