Surviving the Medical Meltdown (27 page)

Better than that home remedy is to have some activated charcoal at home (about a 15gm bottle) and give that as soon as possible. This may cause vomiting, but it is the best thing to inactivate many poisons. Even if charcoal is given, seek attention unless you can get definitive advice from a poison center. Do not use activated charcoal for caustic substances. Every passage of the substance through the mouth and esophagus increases contact time and possibly the chemical “burn.”

MUSTARD DRINK

1 tablespoon mustard

1 cup warm water

Mix well with a spoon and drink rapidly to induce vomiting.

CAUSTIC HOUSEHOLD CHEMICALS

Ammonia

Bleach

Carpet shampoo

Dishwasher detergent

Drain cleaner

Fingernail polish

Kerosene

Mold and mildew cleaners

Oven cleaner

Toilet bowl cleaner

VENOMOUS BITES

Most bites are harmless. Some become infected on a delayed basis. And some are accompanied by
envenomation
, or the injection of a toxic substance that causes death of the surrounding tissues or even patient death.

It is normal to have a red mark and swelling after an insect bite (think the standard mosquito bite). But if you have been bitten by a spider, scorpion, insect, or snake, such as a rattlesnake that is known to be venomous, or you start to experience any systemic
symptoms after the bite, such as sweating, numbness, fevers or chills, shortness of breath, vomiting, facial swelling, tingling or numbness of the extremity, or progressive swelling near the bite, seek help because these bites need antivenom emergently. Call the poison center at 1-800-222-1222 and/or 911 to be directed to the nearest facility with antivenom. DO NOT APPLY ICE to enven-omations from anything – snake or spider. Ice activates the venom and makes things worse. Keep the limb at heart level, and rush to the nearest antivenom facility. If possible, splint the extremity, being careful to allow for swelling. Remove all rings and any constricting bracelets. You can wash the area in soap and water, but do not try to “suck out the venom,” as this puts the venom under your tongue, where it may be even better absorbed.

COMMON NONTOXIC SUBSTANCES

Bubble bath

Crayons

Chalk

Candles

Deodorant

Eye makeup

Household bleach

Laundry detergent

Lipstick

Lotion

Perfume

Play-Doh

Silly Putty

Soap

Toothpaste

Watercolors

EMERGENCY CARE FOR VENOMOUS BITE WOUND

1.
Call Poison Control at 1-800-222-1222 or 911 to find the closest facility with antivenom.

2.
Arrange transportation; do not drive yourself.

3.
Remove all rings and constricting bracelets or clothing.

4.
DO NOT APPLY ICE.

5.
Elevate the extremity slightly above the heart and rest it. Splint if possible.

6.
Do not enlarge the wounds or suck out the venom.

Cats are notorious for puncturing small joints in the hand or the tendon sheaths with their little sharp, pointed teeth. This can result in deep hand infections. The problem may develop over twelve hours or several days. The same can be said for human “bites” because they often involve the knuckles (as in punching someone in the mouth) or become infected due to the strange bacteria that we harbor in our mouths. Any generalized redness or swelling after such a bite should be evaluated professionally. Any small, local redness and swelling can be observed and treated with frequent warm soaks (at least three times a day) and antibiotic cream or ointment. Bites from animals, such as dogs, ferrets, hamsters, or gerbils, are much less likely to cause joint penetration or deep infection because of the nature of their teeth and the germs in their mouths.

Finally, there is the issue of rabies. Rabies deaths in the United States are rare – fewer than ten a year. But forty thousand people are exposed and vaccinated. The vaccine is 100 percent effective at preventing the disease – even after exposure – but the disease is 100 percent fatal if contracted from a rabid animal. (Exposure to the disease is not the same as contracting the disease.) Rabies occurs quite often in populations of raccoons, foxes, skunks, coyotes, bobcats, woodchucks (groundhogs), beavers, and other large carnivores. Small mammals, such as squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, rabbits, and hares are almost never found to be infected with rabies and have not been known to cause rabies among humans in the United States. Rabies is rarely seen in domestic cats and dogs, but these bites account for more rabies testing because fewer people are bitten by woodchucks.
¹

Any bite by a wild animal should be reported to the local health department or discussed with an emergency physician. Local health departments are given updates on rabies probability and protocols, and they can give the best advice. If that help is not available, it is critical to observe the vaccinated animal for ten days, an unvaccinated animal forty-five days. If there is no sign of rabies at that point, then no further treatment is needed.

Bats pose a different problem.
²
Of the approximately ten deaths a year from rabies, most are from exposure to a rabid bat. Any contact with a bat is of concern because the virus can be transmitted through superficial wounds or mucous membranes. If a bat is found in a house and if the possibility exists of unrecognized direct contact – for example, a sleeping baby in the room with the bat – it is best to capture the bat and call the local authorities. All wounds from bats must be considered rabid until proven otherwise. If the bat cannot be captured and there is any question of contact, the current recommendation is to vaccinate the potential victim. Symptoms of rabies generally occur two months after exposure, and vaccination even weeks after exposure prevents the disease. Should the medical care system collapse temporarily, you will have time to sort this out and possibly be able to locate rabies vaccine when needed.

Human bites are a problem because of the bad germs we carry in our mouths. If there is contamination of mouth germs to the wound or if the wound is ragged, deep, or puncturing or in the hand or tendons, you are best advised to seek help. If that is not available, cleanse the wound and leave it open – do not attempt to close a human bite. Cipro and clindamycin in combination may ward off infection. It is important never to lie to your treating physician about these wounds even though they frequently involve a fistfight where the knuckles hit the other combatant’s tooth. Without knowing that fact, the doctor may undertreat the injury and a serious infection could ensue.

FEVER WITH OTHER SIGNS OR SYMPTOMS

Fever causes many unnecessary trips to emergency rooms. By itself, it is the body’s adaptive response to infection. Fever is, in most cases, our friend. Much evidence suggests we should never use drugs to lower the fever because doing so prolongs the illness or increases the chance of death and disability. Years ago, studies were done in India using various antipyretics – temperature-lowering drugs
– in children with tuberculosis (TB) or with polio. In cases of TB, those given diclofenac or aspirin to lower their temperature were found to have a higher death rate and a longer course of active disease before the body walled off the invading germs. In polio cases, similarly, paralysis and death were increased by chemically lowering the temperature. Because chemicals that lower temperature also alter the body’s immune response, we cannot generalize these findings to lowering temperature mechanically. In other words, using grandma’s method of lowering the temperature by tepid water baths and sponging, or putting on a moist T-shirt for evaporation, may not make things worse, but we do not know for sure. My approach is to tolerate most temperatures for as long as possible, and only when truly miserable do I sponge down or do the wet T-shirt trick.

So when do we go to the ER? If the fever is accompanied by other significant symptoms – such as severe headache, neck stiffness, change in mental status, unremitting nausea and vomiting, vision changes, seizures, generalized rash, severe abdominal pain or distention, or worse – go to the ER, calling 911 if needed.

If the fever is over 104 and persistent in spite of cooling, go to your physician or the local emergency room for evaluation. Even as a physician I believe in instinct. Instinct is really just your subconscious mind putting all the facts together, but not making you aware of the ongoing logic. There is a big difference between a child with a temperature of 104 who looks good, acts right, and whose temperature is easily brought down through sponge baths, and a child who appears very ill, is listless, and whose temperature does not respond to home remedies. The former I would feel comfortable watching at home. The latter I would take to the emergency room.

SPONTANEOUS BLEEDING

Many times when we are bleeding, we know what caused it. Sometimes, though, people can spontaneously start bleeding. Usually it is out of the nose. It is very common for kids to have nosebleeds,
maybe even several. But any bleeding that is unstoppable from the nose after a reasonable period of direct pressure should be taken in for professional packing and evaluation. An old-fashioned treatment for nosebleed, which has made a comeback, is packing with salt pork. For some reason cured pork packed into the nose stops bleeding even in people with bleeding disorders.

STOPPING A NOSEBLEED

1.
Sit down and pinch your nose for at least 10 minutes (without peeking to see if the bleeding has stopped). Set your watch to confirm the time.

2.
Keep the head above the heart to reduce blood pressure to the nose.

3.
Lean forward so blood will pool in the nasal cavity, not run down the throat.

4.
Use ice over the nose. (A bag of frozen peas is also excellent for this.)

5.
If unsuccessful, place a piece of raw salt pork or bacon into the nostril, then apply pressure.

6.
Repeat for up to 30 minutes, and if bleeding persists, seek emergency room care.

Any bleeding from any other orifice is significant with one exception. A small amount of blood on a toilet tissue after a bowel movement, or even drops of bright-red blood into the toilet, does not constitute an emergency but should be evaluated in a medical clinic. Bleeding from the bowel that continues for longer than a few minutes, vomiting blood, or copious blood from the rectum is reason to seek urgent care.

Spontaneous bleeding from the gums or uncontrolled bleeding from brushing your teeth or bleeding significantly out of proportion
to the injury (hours of bleeding from a paper cut, for example) may be a sign of a blood or clotting disorder. This needs evaluation by a professional. If the bleeding can be stopped, it is not necessary to rush into an ER in the middle of the night, but do not wait more than the next day. The next bleed may be unstoppable.

INABILITY TO URINATE OR DEFECATE (HAVE A BOWEL MOVEMENT)

Sometimes if you are dehydrated, you may not void as normal, but sometimes there is a sudden blockage. Try taking clear liquids. If you cannot void at all or you feel your bladder or bowel is distending or “blowing up” in size, don’t wait. This needs to be treated professionally and urgently. It may resolve spontaneously, but you still need to get it checked out.

Similarly, if you feel progressively bloated and cannot pass feces or gas, you may try drinking fluids, taking an enema, and/or drinking a laxative. If you have no luck getting gas to pass and feeling better, seek help. If you “decompress,” you can wait until the morning, at least; but you need to be checked out. Significant bowel distention may be the harbinger of other diseases, such as cancer or infection or obstruction from an old surgical scar.

LESS SERIOUS CAUSES OF ABDOMINAL PAIN

Abdominal muscle strain

Dehydration

Diverticulitis

Food poisoning

Gallstones

Hernias

Indigestion

Irritable bowel syndrome

Kidney stones

Muscle hernia

Shingles

Urinary tract infection

Viral gastroenteritis with or w/o vomiting

ABDOMINAL PAIN

A certain abdominal tenderness or pain is to be expected if you have a flu-like illness and are vomiting. You can also pull an abdominal wall muscle. BUT persistent pain, especially localized to one area of the abdomen, abdominal pain accompanied by inability to pass gas or feces
or urine, abdominal pain and fever – those conditions probably warrant a trip to the ER.