CHAPTER VIII

DANGERS AND PRECAUTIONS — ACCIDENTS AND

EMERGENCIES

Some of the more common dangers to be guarded against are the picking up of pieces of glass, tin, tacks, nails and sharp instruments and secreting them for future use; the breaking of windows, dishes, picture glass and mirrors to obtain glass with which to cut the throat or wrist; swallowing safety pins, glass, nails, hair-pins, rags, spoons, the metal tops of salt shakers and other articles; eating matches, soap and soap powder, drinking ink, floor polish, paint, kerosene, gasoline or anything which can be found; strangulation by means of rope, belt, bath robe cord, stocking, towel, necktie or strips of sheet, blanket or clothing which have been twisted and braided into a rope or cord; asphyxiation by inhaling illuminating gas or by drowning in the bath tub; escape by opening doors and windows by means of bent wire or hair-pins, and with keys which have been stolen from nurses and attendants; leaping out of windows or down stairways, in front of automobiles, teams, trolley cars, and into river, lake or stream if conveniently located.

Poisonous drugs should never be kept in a room or on a ward where there are irresponsible patients, unless carefully guarded by lock and key. The best plan is to have the medicine chest in a room into which the patients are never permitted to go, and even there it should always be locked. Antiseptic solutions must not be allowed to stand unprotected for even a very short period. When surgical dressings are being made and solutions and instruments used, constant watchfulness must be exercised and maintained.

Accidents and emergencies. The nurse must at all times

be prepared to meet emergencies, for among the mentally ill many forms of accidents occur primarily because of the disordered condition of the mind. She must not, even when facing a serious accident, allow herself to become excited, but must keep her poise and presence of mind, give no alarm to other patients, and by her calm manner reassure them as well as the patient to whom the accident has befallen. She must act quickly, using her best judgment as to the measures to be applied to relieve the immediate danger, summon the physician and make ready those things which he will need on arrival. If the patient's condition is serious, the nurse must remain constantly with him and direct others to run the necessary errands and make the needful preparations. The prompt application of simple emergency measures will many times save the life of the patient.

Choking. Remove the obstruction by opening the mouth and hooking it out with the forefinger. If it is in the larynx, and coughing would indicate this position, give a sharp blow with the open hand between the shoulders; or if it is in the esophagus, give a drink of water, a piece of bread or some soft food to swallow. If these measures fail, use the pulmotor if it is available. To prevent the patient swallowing some object or article already placed in the mouth, bend the head forward on to the chest and hold it in that position until help arrives, when the mouth can be opened and the object removed. If glass, pins or other sharp objects have been swallowed, bread and other solid food should be given so that they may be imbedded and carried along with less damage to the mucous membrane of the intestines. Cathartics must not be given except by direct order of the physician.

Asphyxia or suffocation is a condition where consciousness is partially or completely lost because of defective oxidation of the blood, and carbon dioxide in excess poisons the body. This may be due to a foreign body in the larynx, or water as in drowning, or compression of the throat as in hanging, and to inhalations of illuminating gas. Loosen all clothing about the neck and waist, provide fresh air, examine the

pharynx for obstruction, give artificial respiration and inhalations of oxygen.

Strangulation. Remove whatever is about the neck; if the body is suspended, first cut it down, taking care that it does not fall; loosen the clothing, open the windows, remove any foreign bodies (false teeth) from the mouth, pull the tongue forward and give artificial respiration.

Wounds. If the trachea has been cut the breathing will be difficult and the blood which is about the wound and comes from it will contain air bubbles. To prevent the blood from flowing into the trachea, turn the patient on the side or on the face and check the bleeding by pressure. Have ready the tracheotomy set for the physician when he arrives, and make other preparations for whatever surgical measures may be required.

If a large artery in the neck is injured, bend the head forward on to the chest and make direct pressure on the vessel with thumb and fingers. If a large vein has been cut, pressure above and below the injury will help to control the flow of blood and prevent air from entering the proximal end. If the radial artery has been injured, place a tourniquet above the elbow, elevate the arm above the head and make pressure above the injury; or a pad may be placed in the hollow of the elbow, the arm forcibly flexed and pressure made on the vessel. Thirst usually accompanies hemorrhage, and water in small quantities should be given often if the patient can swallow; if not, saline solution per rectum should be given.

Clothing on fire. Prevent the patient from running as this fans the flame and makes it spread more rapidly. If it cannot be extinguished quickly place her on the floor and roll in blankets or a rug. Protect the head with a wet towel so that the flames will not be inhaled. In all cases of burns there is always more or less shock. This is indicated by weak, rapid heart action, cold skin, pallor, feeble or sighing respiration and sometimes by nausea. This condition should be treated immediately by placing the patient in bed

with the head lowered (the foot of the bed may be elevated on a chair), cover with warm blankets and apply heat. Do not attempt to remove the clothes or apply dressings until the pulse becomes stronger, or definite orders have been received from the physician.

Burns may be of two kinds, physical or chemical. Burns and scalds caused by fire, hot water or steam should be treated by applying a saturated solution of sodium bicarbonate or vaseline and dressings to exclude the air. If blisters have been raised, these should be drained and the burned skin cut away to prevent sloughing, and a dressing of boracic acid ointment or Carron oil (equal parts of linseed oil and lime water) applied. Burns produced by acids should be treated with a solution of sodium bicarbonate or some other alkali; if caused by strong alkali, lemon juice or vinegar should be applied; burns produced by phenol should be treated by the application of alcohol. All dressings should be securely put on so that they cannot be removed. Delirium frequently develops after severe burns, and injuries must be guarded against.

Drowning. If the patient is breathing when rescued, place him at once in bed, cover him with warm blankets, apply heat and friction to the body, or place him at once in a hot bath which will furnish the stimulation. If the respiration has ceased, place the body face downward, a folded blanket or garment under the chest, so that the shoulders and head are lowered and that the water may drain from the lungs; wrap the body in blankets and apply heat; gauze or a handkerchief may be moistened with aromatic spirits of ammonia and held to the nostrils; clear the mucus from the mouth, and briskly rub the upper part of the body. If breathing does not begin at once, give artificial respiration and continue to do so for a long time.

Fractures. The signs of fracture are pain and tenderness about the point of injury, inability of the patient to move the part, deformity which may be seen or felt, crepitus, swelling and discoloration. The first thing to be done is

to place the patient in as comfortable position as possible; then remove the clothing, ripping the seams if necessary, beginning on the side opposite the injury. Move the limb no more than is absolutely necessary, as the jagged ends of bones may lacerate the tissues, or perforate a blood vessel. If the limb must be moved slip both hands underneath and grasp the bone at two points a little distance from the fracture on both sides, making extension on the distal side so that the ends will not rub together. Place in the position desired and support if necessary with pillows or pads. If the fracture is compound an antiseptic dressing should be temporarily applied. Get together splints, bandages, adhesive plaster and whatever else the physician will need when he arrives. In fracture of the skull there is very little a nurse can do except to keep the patient as quiet as possible, apply cold compresses to the head, be on the lookout for hemorrhage from the ears and nose, and guard against injury should convulsions occur.

Dislocations are very painful and produce many of the symptoms of fracture. The nursing procedures are to remove the clothing, support the joint if it is more comfortable and apply cold compresses. If the dislocation is only partial, some simple manipulations, the performance of some of the ordinary movements of the particular joint, will reduce it.

Poisons are sometimes taken by mistake or accident and sometimes with deliberate intent for the purpose of self destruction. Most of the poisonous drugs produce symptoms so sudden and severe that the nurse's attention would be attracted, even though the patient might not make any complaint and stubbornly declare he had taken nothing to cause them, and upon the correct interpretation of these symptoms and the prompt application of first aid measures the life of the patient may depend. When the symptoms and the circumstances indicate that a poison has been taken the nurse should at once send someone to call a physician, and set about to find out what drug and how much of it has been taken. No time should be wasted in searching