How to Meet Emergencies by F. C. Richards

Review and Herald Publishing Association · Takoma Park Station, Washington, D. C. · Mar 31, 1910

How to Meet Emergencies

By F. C. Richards

F. C. RICHARDS, M. D., C. M.

Minor Surgical Emergencies

EVERY home has its nurse, though she may not be known by that title. Mothers and elder sisters generally act as home nurses, and it is with the object of helping these that this article is written.

There are various branches of nursing, one of which is surgical nursing. By emergency surgical nursing is meant the proper dressing and care of wounds and injuries of various kinds. The home nurse is often called upon to treat minor surgical emergencies, such as cuts, bruises, punctured wounds, burns, scalds, sprains, the bites of animals, stings, etc.

It has been said that the fate of an injured person depends largely upon the acts of the person into whose hands he first falls. There is certainly much truth in the statement, for trivial wounds are often made serious by bad management and unwise treatment. For example, the case is recalled of a slightly bruised leg which was transformed into an ugly, poisoned, suppurating limb by the application of kerosene. This remedy may safely be applied to the hide of a rhinoceros, but ought never to be brought in contact with delicate, bruised, or broken skin. One occasionally finds a piece of fat pork or a tobacco poultice bound on to a hot, red, swollen member; cabbage leaves are a favorite dressing in some quarters; dusty cobwebs are sometimes stuffed into wounds to stop bleeding; and a marble or stone has at times been bandaged in to keep a wound open. Of course all such unwise acts as these only complicate injuries and endanger lives. The first rule, then, for safety’s sake is, If you don’t know what to do, do nothing. But that is a poor rule to follow, for some one may bleed to death or die of poisoning from snake-bite, if you don’t know what to do. Learn, therefore, as quickly as you can, the right thing to do; and then—do it.

The great underlying principle in all modern methods of wound treatment is cleanliness—not simply ordinary cleanliness, but fire and boiling water cleanliness. Absolute safety and unvarying success in the treatment of wounds of all kinds lies in literally passing through the fire everything that comes in contact with the wound. The water used to wash a wound, the cotton cloths or other dressings bound upon it to stop bleeding and protect it, the scissors used to cut the cloths—these and all else should be boiled. Surgeons and surgical nurses boil all their instruments and dressings, and would boil their hands if they could, before bringing them in contact with wounds. The hands should at least be well scrubbed with soap, plenty of hot water, and a nail-brush that has been boiled.

The home nurse should have at hand a supply of soft, clean cotton or linen cloths. Cheese-cloth or gauze answers admirably. These may be kept free from dust and germs in a wide-mouthed glass bottle or jar with an over-fitting lid. A Mason or similar fruit-jar answers nicely. These cloths should be baked in the bottle after the lid has been partly screwed on. The heat of the oven sterilizes the cloths, making them ready for immediate application to a cut finger or other injured member. Those who prefer, may purchase small packets of sterilized surgical gauze or lint.

With such sterilized dressings at hand, any wound can be quickly covered with material which is surgically clean. This quick covering with clean cloths is a vital point in the first-aid treatment of wounds, as it seals the wound and prevents the entrance of germs from the air or through contact with soiled clothing and unwashed hands. It is the method followed on the battle-field in modern wars, with excellent results. After such a dressing has been snugly bandaged in place, if the wound is at all a serious one, the services of a surgeon should be secured. If this is impossible, the wound will soon have to be cleansed by the home nurse, and the following rules should be carefully observed:—

Boil the water with which the wound is to be washed for at least ten minutes. For a large wound, several gallons should be boiled, part being cooled as rapidly as possible by placing the vessel containing it in cold water.

While the boiled water is cooling, scrub several china or enameled bowls or basins with soap and hot water, rinsing with boiling water.

The nurse’s hands should next be prepared. To do this bare the arms to the elbows, and with a portion of boiled water in one of the sterilized basins scrub the hands and arms with antiseptic or good laundry soap, and the nail-brush previously boiled. Give special care to the cutting, cleansing, and scrubbing of the nail and crevices. Remove rings, if any are worn. After scrubbing for ten minutes, pour boiled water over the hands and arms to rinse off the soap. Finally, scrub the hands with sterilized cloth over which alcohol or methylated spirit has been poured by an assistant.

After being cleansed by the above method, the hands should be permitted to touch nothing except water, the inside of sterilized basins, and dressings and instruments which have been boiled. The outside of sterilized basins and the outside wrappings of sterilized dressings should be handled by an assistant. Soiled clothing and outside bandages should also be removed by an assistant whose hands have been washed in the ordinary way, and are not permitted to come in contact with the injured surface or sterilized materials.

The wound should now be cleansed by boiled water being poured over it, first as hot as can be borne, then cold, a half dozen or more changes from hot to cold being made. The water may be poured from a sterilized basin or jug, or allowed to flow over the wound from a piece of sterilized dressing held above the wound, but not brought in contact with it.

Do not mop or scrub the wound.

Splinters of wood, bits of grass or clothing, and other foreign matter should be picked out of the wound with sterilized forceps (tweezers) or scissors rather than with the fingers. Grease, soot, and dirt are best removed by wiping the wound gently with a piece of sterilized gauze previously moistened with turpentine.

If it is necessary to replace torn portions of flesh, these are best handled with the fingers covered with sterilized gauze. Never clip off pieces of skin or flesh that may seem almost torn away, as such parts may be valuable. No one but the surgeon can decide what parts should be removed.

After the wound has been cleansed, cover it with a dozen or more thicknesses of dressing material which has been moistened and sterilized by being boiled. On top of this sterile wet dressing pile sterile dry dressings an inch or two in thickness, bandaging all firmly in place. The best and cheapest material for the dry dressings is sterilized cotton-wool, which may be obtained from any chemist.

Once covered in this way, it is important that the wound should be kept covered to exclude all dust and germs. When the patient’s condition is satisfactory, there being little or no fever or other unfavorable symptoms, this first dressing may be left in place for several days. Surgeons do not uncover their wounds for a week or more if all goes well.

In case the wound is infected, however, as shown by slight fever and inflammation of the wound with, later, more or less discharge, the dressings should be frequently changed and the wound cleansed with hot and cold boiled water after the manner already stated. At least twice daily a freshly boiled wet dressing should be bound in place on such a wound. Burns and wounds of all sorts heal more rapidly under a boiled-water compress than when treated by any other method.

Punctured wounds made by nails, thorns, bits of glass, pins, needles, etc., should be encouraged to bleed freely by the alternate application of hot and cold water. The offending object should be removed if possible, and the wound covered with a piece of boiled linen or other sterilized dressing. To remove a splinter or other imbedded object, boil the small blade of a pocket-knife, or pass the point several times through a flame to sterilize it; scrub the fingers and clean the nails which are to be brought in contact with the wound; slip the point of the knife-blade under the end of the splinter or other object, pressing the splinter firmly against the knife-blade with the thumb-nail, and draw the foreign object out. It may be necessary to enlarge the wound in order to reach the splinter.

To remove a fish-hook push the barbed point through, file or cut it off, and then withdraw; or cut off the ringed end and push the fish-hook right through. If the barbed point is pulled back through the flesh, considerable damage will be done.

Bruises should at first be covered with cold wet cloths, which are frequently changed. Later, very hot compresses may alternate with the cold.

Wounds made by the stings of ordinary insects are best treated by the application of ammonia, baking-soda, or table salt.

Cooranbong, New South Wales.