- The Washington Times - Sunday, April 23, 2000

It could make an emergency from a skinned knee to a broken arm much less traumatic. Tuck it outof sight, yet keep it close somewhere.
It is a first-aid kit, and every home should have one, says Dr. Tiffany Osborn, an emergencyphysician at the University of Maryland's Shock Trauma Center inBaltimore and a spokeswoman for the American College of EmergencyPhysicians.
"A first-aid kit can do two things," Dr. Osborn says. "Itcan treat potential injury and can contain in one place importantinformation that you need in case someone has to go to the emergencyroom."
A home first-aid kit does not have to be complicated orexpensive, she says. A few basic items can be a useful in severalsituations.
Gauze pads in a variety of sizes can help treat a varietyof cuts and scrapes, says Dr. Julian Orenstein, a trauma physician atInova Fairfax Hospital for Children.
"Gauze can work for just aboutanything," he says. "Pads can help stop bleeding and can keep a woundcovered. There is always less stinging when air is not over awound."
Other helpful items for cuts, scrapes and burns are bandagesin different sizes, antibiotic ointment, adhesive tape, scissors forcutting the tape and hydrogen peroxide, Dr. Orenstein says. Hydrogenperoxide, which can be applied with a cotton swab, is particularlyhelpful to clean out a "dirty" wound such as a scrape, he says.
Anelastic wrap, such as an Ace bandage, can be helpful for wrapping wrist,knee or ankle injuries. A large, triangular bandage also can wrap largemuscle injuries or act as a sling to immobilize an injured arm orshoulder, Dr. Osborn says.
She also advises adding a few disposable,instant ice packs to the kit. These ice packs do not need to be keptcold, but activate when you squeeze them.
They can be quite useful inreducing swelling in a sprained wrist or ankle, she says.
Also helpfulare safety pins to hold a sling in place, rubber gloves and tweezers,Dr. Osborn says.
"Tweezers can be useful if you have to remove asplinter or a tick," she says. "Rubber gloves can offer protection forthe caregiver if the injured person is bleeding."
A first-aid kitshould contain medications, both all-purpose for the whole family aswell as specific medications for individual family members (such asallergy or asthma medication), she says.
"I would keep a bottle ofacetaminophen or ibuprofen," Dr. Osborn says. "I would not keep aspirinon hand because of the risk of Reye's syndrome in children andteen-agers."
If a family member is dependent on an asthma inhaler, anextra one should be kept in the kit, she says. An epinephrine pen, whichcan inject adrenaline and save a person from a potentially severeallergic reaction, also should be included if a family member isallergic to bee stings or particular foods.
Syrup of ipecac, amedication that induces vomiting in a person who has swallowed somethingpoisonous, should be kept on hand but should only be used aftercalling poison control, Dr. Orenstein says.
"Syrup of ipecac is a goodone but a difficult one," he says. "In the [emergency room], if we needto, we can put a tube down the nose to the stomach to get at what wasswallowed. Sometimes we are better at knowing what someone took. Manyhousehold cleaners are nontoxic. Only lye is really, really a dangeroussubstance."
Says Dr. Osborn: "I would say never just automaticallytake ipecac. Always call poison control first, then do what they say. Inmany instances, taking ipecac can cause more harm than good. I wouldhave the number for poison control located on the first-aid kit, sosomeone like a baby sitter would have it in more than onespot."

Putting it in writing

Certain paperwork belongs in thefirst-aid kit, too, Dr. Osborn says.
Information on each familymember, their medical history (including immunizations and the date ofthe last tetanus shot), allergies, insurance information, the name andnumber of the family's primary care physicians and emergency contactnumbers should be kept in the kit.
Another important item anemergency consent form, which allows a baby sitter or relative to makeemergency medical decisions for a child could be extremely helpful,Dr. Osborn says.
"I would make a couple of copies so you can changeinformation when necessary," she says.
An emergency consent form canbe found in the American College of Emergency Physician's free HomeOrganizer for Medical Emergencies. (See the "More info" box nearby forthe address.)

What to do?

One thing that cannot go in the kit is theintuition to go to the emergency room at the nearest hospital.Sometimes, such as in the case of serious bleeding or broken bones, theanswer is obvious. Other times, a wait-and-see approach is moreappropriate.
"The No. 1 most important thing is a sense of thesituation," Dr. Osborn says. "If you don't feel comfortable, you shouldgo to the emergency department."
Other options in less-serioussituations include calling or visiting the family physician orpediatrician, but some doctor's offices do not handle all emergencies.For a wound that needs stitches, for instance, the family doctor mayinstruct you to bypass his office and go to the emergency room.
Dr.Osborn recommends going immediately to the hospital in severalsituations. They are:
Gaping cuts, long cuts or cuts on theface.
A dirty wound that can cause infection.
Stepping on a nailor a tack, especially if it has been five years or more since the lasttetanus shot.
Large burns, with a blister of more than 1 inch.
mInsect stings on a person who is known to be allergic (or a firstreaction that includes facial swelling or hives). If a person is knownto be allergic and there is no EpiPen available, Dr. Osborn recommendscalling an ambulance. Paramedics carry the drug, which can save aperson's life in a severe reaction.
Dog bites. Dog bites are dirtywounds that need to be cleaned out, and antibiotics need to beadministered. If one does not know the dog, rabies treatment can bestarted.
A potential sprain or broken bone sometimes takes a littlemore evaluation, Dr. Osborn says. She recommends that children proceedto the emergency room or their doctor's office.
"Ligaments arestronger than bones," she says. "Many times it may feel like a sprainbut may be a small fracture. For adults, if you are not able to walk orthe area is swelling more than it should or you are in extreme pain,those are all good indicators to go to the hospital."
If the pain isnot that intense, elevating the area and putting ice on it may suffice,Dr. Osborn says.
In the case of an obvious break, items from thefirst-aid kit may help until a doctor can look at the injury. Splintingthe limb by positioning it against anything flat and stiff (such as aboard or a book) and wrapping it in an elastic bandage will help theperson feel more comfortable and will help immobilize the injury untilemergency help arrives, Dr. Orenstein says.
In the case of excessivebleeding, Dr. Orenstein recommends applying direct pressure to thewound.
"Making a tourniquet is never recommended for bleeding," hesays. "It sounds like it should make sense to cut off something that ispumping, but robbing blood and oxygen to the rest of the limb is not agood thing to do. Direct, firm pressure is always the best way togo."
By keeping good supplies on hand and being prepared, parents canstay calm if a child is injured. That levelheadedness is an importantintangible when it comes to first aid.
"Kids are watching you if theyare in an emergency situation," Dr. Osborn says. "How you react willtell them how dangerous a situation they are in. It is important to stay as calm aspossible."

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