Health

Is there a Doctor in the House?

by Jenna Anderson

With the summer months come a host of activities—at home, on the playground, in the water, on the road. And with those activities comes the risk of injury. Should a loved one fall, choke, have trouble breathing, faint or experience a severe cut or head wound, would you know what to do? When should you call 911? How do you differentiate between a manageable situation and an emergency?

When it comes to basic first aid, there are simple, everyday tips that apply to children and adults alike. The first and most obvious precaution is contact information, according to Dr. Jennifer E. Tucker, MD, assistant professor of emergency medicine and pediatrics at the MCGHealth Children’s Medical Center. Post your family doctor’s telephone number as well as the number for the poison control center (800-222-1222) on your phone and/or refrigerator, she advises. Make sure that parents, grandparents, caretakers, daycare providers and in-home babysitters have immediate access to these numbers.

“Everyone who takes care of children in any capacity should be skilled in the management of several basic injuries, ranging from skinned knees to broken arms to neck injuries, and medical conditions, ranging from allergic reactions to ingestions to choking to drowning,” says Dr. Tucker. While knowing what to do in an emergency is crucial, in critical situations it is imperative to either call for an ambulance or make a trip to the emergency room. However, in order to best be prepared, Dr. Tucker recommends attending the first aid and cardiopulmonary resuscitation (CPR) classes offered every month by the American Red Cross. These courses include basic first aid, babysitting training, infant/child CPR and adult CPR/AED (automated external defibrillator)/first aid training. “First aid classes teach basic management of everything from minor cuts and scrapes to serious bone and joint injuries,” she says. “Children between the ages of 11 years and 15 years may enroll in babysitting training, a course that teaches aspiring babysitters how to keep their potential charges safe and how to manage emergencies such as illnesses, injuries and household accidents. The infant/child CPR training educates individuals on the recognition and treatment of breathing and cardiac emergencies in children under the age of 12 years, while the adult CPR class focuses on the same emergencies in those over 12 years of age. AED training is available for individuals who are certified in infant/child CPR and adult CPR. Every parent/caretaker should consider taking a first aid class and the infant/child CPR class in order to be well-prepared in the event of an emergency in a child.”

Dr. Tucker also emphasizes the need for two first aid kits, one each for the home and car. The home kit should include adhesive tape, gauze bandages of varying sizes (including rolls), antibiotic ointment, metal finger splints, an Ace bandage, alcohol pads, Band-Aids, instant cold packs, disposable gloves, scissors, tweezers, instant hand sanitizer, saline eyewash solution, a thermometer and a first aid manual. Important medications to have available include acetaminophen and ibuprofen for pain/fever, an oral antihistamine in the event of an allergic reaction and even an EpiPen—a self-injecting shot of epinephrine prescribed by your physician for severe allergic reactions. For the car she adds a face shield or a pocket mask, allowing for safe administration of rescue breaths or mouth-to-mouth resuscitation to a stranger.

There are instances, however, when time is of the essence, decision-making is crucial and you must act quickly. Example: Your child suffers a playground injury. His head is bleeding, but he is conscious and crying. Do you treat the cut at home or take him to the hospital?

“It depends,” says Dr. Tucker. “If your child did not lose consciousness, is not vomiting and is behaving appropriately, then he or she can be managed at home—as long as the cut is non-gaping and the bleeding is controlled.”

Application of ice to bruises and antibiotic ointment (Neosporin, Bacitracin) to any scrapes or cuts should be adequate therapy in combination with administration of acetaminophen for pain. If, however, the child has suffered loss of consciousness (including amnesia of the event), has vomited more than once or twice or is acting abnormally, he or she should be brought to the hospital for evaluation. If the cut is actively bleeding or is gaping open, it is also appropriate to take a child to the hospital for possible wound closure with either staples or stitches.

Example: You are at home with a sick child. They have a fever and suddenly begin vomiting. Emergency? “Isolated vomiting in the setting of fever is not necessarily an emergency,” says Dr. Tucker. “If you are concerned that your child is in pain, is becoming dehydrated (dry mouth, sunken eyes, decreased tears, decreased urine output, sunken soft spot) or is acting abnormally (very irritable or difficult to arouse), then it is reasonable to call your pediatrician about a potential visit to the ER.” She goes on to say if your child is unable to keep down fever medication because of the vomiting, then acetaminophen may also be administered rectally every four hours via suppository, a preparation that is available over the counter. If your child continues to vomit and develops the aforementioned signs of dehydration, or if your child has bilious (bright green) vomiting, then you should bring him or her to the hospital immediately, as green vomiting can indicate an intestinal blockage (bowel obstruction). If your child is difficult to arouse or is inconsolable, then you should seek immediate medical attention because lethargy or inconsolableness in the setting of fever and vomiting may indicate a serious infection.

Exercise common sense in any emergency situation, she cautions. Never, ever put yourself at risk—call in trained medical professionals and let them do their job. Err on the side of caution and call 911 if you feel you cannot handle the situation, or if bleeding does not stop with the application of direct pressure. If a child is significantly injured, do not attempt to treat him or her yourself. In the setting of a non-breathing, unresponsive person over the age of 8, 911 should be called immediately before basic CPR is attempted—phone first, Dr. Tucker notes. “Exceptions to this rule would be a drowning victim because quick action to restart the breathing can save a life. In children under the age of 8, it is always appropriate to attempt to restore breathing before calling 911—phone fast. The majority of cardiac arrests in this age group are from lack of oxygen, so the performance of two minutes of CPR prior to calling 911 may be lifesaving. You can also ask someone to call 911 for you while you tend to the child.”

A few more tips from Dr. Tucker include the following: First, while MCG does not offer an actual “Ask a Nurse” service, should you find yourself unable to reach your family doctor, their Children’s Medical Center emergency department, at (706) 721-5101, will answer certain medical questions. “Our nursing staff will offer medical advice regarding problems such as basic fever management, basic first aid and wound management, and will refer parents to our physicians for more complicated questions about signs of dehydration, home management of allergic reactions and doses of fever medicines,” she says. “We always offer parents the option to bring their children to the ER if they feel emergency treatment is indicated. In the event of a life-threatening emergency, we will recommend that parents dial 911 to activate the EMS system.”

Second, she urges everyone to learn CPR. “According to the American Heart Association, 75 to 80 percent of all out-of-hospital cardiac arrests occur at home, and 95 percent of sudden cardiac arrest victims die before reaching the hospital,” she says. “Brain death begins to occur as soon as two to four minutes after cardiac arrest in the absence of CPR or defibrillation, and survival diminishes by seven to 10 percent for every minute of delay in intervention. Based on these statistics, it is estimated that immediate and effective bystander CPR can double a victim’s chance of survival. I would wholeheartedly recommend that everyone take at least a basic CPR class because even the simplest of interventions can be lifesaving.”