# 10 Common First Aid Mistakes



## The_Blob (Dec 24, 2008)

Sometimes, the first aid measures taken on the scene before a patient arrives at the hospital can make all the difference. Here are the 10 most common first aid mistakes (probably not by anyone on this board) -- and what you should do instead. Unfortunately, getting to medical personnel in a timely manner isn't always possible.

1. Cut off finger part

Don't try to preserve the loose part by placing it directly on ice.

Do wrap the severed part in damp gauze (saline would be ideal for wetting the cloth), place it in a watertight bag and place the bag on ice. Then be sure to bring the bag and ice to the emergency room. As for the wound on the hand or body, apply ice to reduce swelling and cover it with a clean, dry cloth.

2. Knocked-out tooth

Don't scrub the tooth hard even if it's dirty (a gentle rinse is OK) 

Do put the tooth in milk and go straight to the ER; there's a chance the tooth could be reimplanted.

3. Burns

Don't apply ice or butter or any other type of grease to burns. Also, don't cover a burn with a towel or blanket, because loose fibers might stick to the skin. When dealing with a serious burn, be careful not to break any blisters or pull off clothing stuck to the skin.

Do wash and apply antibiotic ointment to mild burns. Head to the hospital for any burns to the eyes, mouth, or genital areas, even if mild; any burn that covers an area larger than your hand; and any burn that causes blisters or is followed by a fever. 

4. Electrical burns

Don't fail to get medical attention for a jolt of electricity, even if no damage is evident. An electrical burn can cause invisible (and serious) injury deeper inside the body.

Do go to the ER immediately. 

5. Sprained ankle

Don't use a heating pad.

Do treat a sprain with ice. Go to the ER if it is very painful to bear weight; just in case you have a fracture. 

6. Nosebleed

Don't lean back. And after the bleeding has stopped, don't blow your nose or bend over.

Do sit upright and lean forward and pinch your nose steadily (just below the nasal bone) for five to 10 minutes. If the bleeding persists for 15 minutes (or if you think you are swallowing a lot of blood) go to the ER. 

7. Bleeding

Don't use tourniquets untrained, except as a last resort! You could cause permanent tissue damage. 

Do apply steady pressure to the wound with a clean towel or gauze pack and wrap the wound securely. Go to the ER if the bleeding doesn't stop, or if the wound is gaping or caused by an animal bite. To help prevent shock, keep the victim warm.

8. Ingestion of poison

Don't induce vomiting or use Ipecac syrup (unless instructed to do so by emergency personnel). 

Do call poison control, and bring the ingested substance with its container to the ER.

9. Being impaled

Don't remove the object; you could cause further damage &/or increase the risk of bleeding.

Do stabilize the object, if possible, and go to the ER.

10. Seizures

Don't put anything in the victim's mouth. 

Do lay the victim on the ground if possible in an open space and roll the victim onto his or her side. Call 911.


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## resqdoc (Dec 15, 2008)

7. Bleeding

Don't use tourniquets except as a last resort! You could cause permanent tissue damage. *WRONG! TQ's are the first line of bleeding control for arterial/firehose bleeding in extremities. They can be removed after proper deep packing & direct pressure bandages are placed & the patient is stabilized. Good modern references to this include the latest PHTLS manual.*

Do apply steady pressure to the wound with a clean towel or gauze pack and wrap the wound securely. Go to the ER if the bleeding doesn't stop, or if the wound is gaping or caused by an animal bite. To help prevent shock, keep the victim warm.


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## The_Blob (Dec 24, 2008)

I believe that "arterial/firehose bleeding" just *might* constitute a rapidly occuring case of 'last resort'... maybe 

The use of tourniquets for the control of hemorrhage from traumatic injury has been long debated. Opinions on the utility and safety of their use in this setting have alternated between strong endorsement and outright vilification of the device, with each of the camps backing up their contentions with varying levels of anecdotal evidence. The debate is largely fueled by experiences of military surgeons during wartime and the results have changed with changing times, differing systems and circumstances in which they have been utilized. Review of the evidence available in the English language medical literature seems to indicate that while neither camp is entirely correct, neither seems to be entirely without merit. The preservation of life- even at the potential expense of a limb- should without a doubt take precedence, but this should not lead to the abandonment of all possible efforts to minimize the length of time that the tourniquet is in place and the thereby reduce the attendant risk of complications.

The control of hemorrhage in the civilian setting is less fraught with serious risk to the first responder than a soldier might face, and therefore is much more able to follow the traditional stepwise approach recommended by most authorities. The advice of Rich/Spencer, which includes packing of the wound with associated arterial hemorrhage, direct pressure and pressure dressings is probably the best approach when sufficient manpower and safe circumstances to allow intervention by *trained and skilled* providers. Outside of situations necessitating expedient evacuation of casualties, the use of a tourniquet will be necessary only infrequently but should be considered in any case where hemorrhage is ongoing and *immediately* life threatening. This approach is similar to that recommended by Aucar/Hirshberg, as well as that recommended by the ATLS (Advanced Trauma Life Support) manuals, as well as the US Army Survival Manual both of which are widely distributed to the general public through civilian publishers.

However, the safest approach in the case of the marginally trained and inexperienced person with only basic first aid training is probably to rely upon simple direct pressure or basic forms of pressure dressing. *This is due to a lack of evidence that such persons can effectively recognize the need for a tourniquet and properly apply such a device*, especially given the likely need to improvise under such circumstances. This last point is illustrated by a sample case of femoral artery transection by broadhead arrow as the result of a deer hunting accident. The victim's nephew had attempted to place a tourniquet made from the victim's belt prior to going for help. The patient was deceased due to blood loss at the time of the arrival of the emergency responders. It was determined that the bystander had improperly placed tourniquet distal to the injury and with insufficient force to be of any utility even if it were in a proper position.

The use of tourniquet as a "stopgap" measure in combat, with "reassessment of the necessity of the tourniquet as soon as situational conditions allow", is part of the Tactical Combat Casualty Care course the United States Army conducts (quoted sections come directly from the PHTLS manual). This emphasis on conversion to less aggressive means of hemorrhage control whenever possible may be one reason that reports from the Iraq theater of operations describe the presence of unnecessary tourniquets upon arrival at medical facilities as infrequent. This attitude has been incorporated into the military version of the PHTLS (Prehospital Trauma Life Support) manual; which is widely used in the education not only of military personnel, but also in the education of tactical medics in the law enforcement community as well. *Even some staunch opponents of the widespread use of tourniquets* (like me) *admit that the temporary use of tourniquets under tactical conditions or similar circumstances is acceptable to effect the safe extraction of the wounded party.* The use of tourniquets, while beneficial to many of those wounded in combat or with otherwise uncontrollable bleeding, is not without its hazards and potential complications. Any use of a tourniquet must be *with full awareness of the risks involved* and to brush these aside would be to abandon one of the basic tenets of evidence based medical practice.

Furthermore, the use of tourniquets during elective surgery has led to reports of cardiac arrest secondary to circulatory overload in patients with poor cardiac reserve resulting from a functional increase in the circulating blood volume. This is likely to not be a factor in a hypovolemic trauma patient but may play a role in the case of a patient with underlying heart disease who is being fluid resuscitated with a tourniquet in place. Tourniquet removal postoperatively has produced transient increases in end-tidal carbon dioxide levels, and transient decreases in central venous pressure and blood pressure. The former may be of significance in a patient with head trauma, but the effect can be minimized through hyperventilation of the patient. Release of a tourniquet has also been described to induce brief systemic thrombolysis as a result of the stimulation of various anticoagulation mechanisms by ischemia. Localized complications have included pain, erythema or localized bullous skin lesions, nerve damage from paresthesias to paralysis of the affected limb, vascular spasm, fracture of atheromatous plaque, muscle injury, gangrene and other infectious complications, edema, to compartment syndrome. The nerve and muscle injuries may be transient or permanent in nature, although the latter is exceedingly uncommon in most settings today where tourniquets are utilized for hemorrhage control. This is due to a strong positive correlation between the length of time the tourniquet is in place and the rate and severity of complications that result. A similar correlation is found to exist with the amount of pressure produced by the tourniquet, but this is mainly an issue with improvised tourniquets and those with a width of one inch or less. It should also be noted that patients with pre-existing neuropathies, such as those associated with diabetes or alcohol abuse, appear to be at an increased risk of nerve injury, and other factors may also serve to predispose patients to nerve related complications.

every rule has exceptions, hence the phrase 'exception to the rule'... but I firmly stand behind the intent of my previous statement, if you are *not* trained sufficiently don't use a tourniquet unless you have to.


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## resqdoc (Dec 15, 2008)

You have to be alive to suffer a complication. You have your opinion, I have mine. Having applied TQ's in combat, civilian settings, the ED, surgery, and so on as well as having numerous providers (from PA's to lay persons) functioning under my teaching and medical control succeed with TQ's, we'll just have to agree to disagree. Field realities versus theoretical ivory tower considerations have little weight with me. Improper use and lack of training is an issue be it a TQ, hemostatic agents, direct pressure, or any medical care. Rather than summarily dismiss something as a last resort, a discussion of the relative benefits and hazards would be welcome. Otherwise, directing interested parties to some initial reading on the matter can be suggested. Have a great day!


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## The_Blob (Dec 24, 2008)

thanks for the passive-aggressive backhand, it has definitely shaken me out of my Ivory Tower.


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## Molon Labe (Nov 6, 2008)

I will trust the research done on this topic

http://www.preparedsociety.com/forum/f3/hemorrhage-control-503/
The bottom part of the first post has links to the studies and white papers.

The EMS agency I am working for now is adding the CAT and Combat Gauze to the protocols for the Fire Department (EMT's) and EMT's and Medics at the EMS service.

PHTLS now says if Direct Pressure does not work go to the TQ. No more Pressure Point and Elevation.


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## dyermaker (Jan 28, 2009)

Why do you put a knocked out tooth in milk? What does the milk do?


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## jones34 (Jul 24, 2009)

Thank's For sharing these Useful Tips With us,Many Of the above said mistakes i use to do many times,but I'm also getting confused with this Point only that Why do we put a Knocked Out tooth in milk,What does this milk help for?????


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## The_Blob (Dec 24, 2008)

The best place to preserve the tooth on the way to the dentist is in its socket. If the person is old/mature/lucid enough not to swallow it, replace it gently, then have the person bite down gently on a gauze pad to keep it in place. If the tooth can't be reinserted, put it in milk, a good preservative because its chemical makeup is compatible with teeth. If milk isn't available, place it inside your own mouth, between your cheek and lower gum. The prime window is generally 30-60 minutes for reinsertion.


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## doc66 (Apr 13, 2009)

In the GSW world tourniquets are back in vogue. The IBD comes with its own!

It comes down to what you are comfortable with.


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## leesa_lk (Sep 7, 2009)

The_Blob said:


> 4. Electrical burns
> 
> Don't fail to get medical attention for a jolt of electricity, even if no damage is evident. An electrical burn can cause invisible (and serious) injury deeper inside the body.
> 
> Do go to the ER immediately.


This is quite true.More than 500 Americans die every year from electrical burns. Best thing to do is going to the ER immediately.


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## eclairez (Mar 14, 2011)

Thanks for sharing! Great info.


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## IrritatedWithUS (Jan 9, 2011)

5. Sprained ankle

Don't use a heating pad.

Do treat a sprain with ice. Go to the ER if it is very painful to bear weight; just in case you have a fracture.

*Use the R.I.C.E method:
Rest
Ice
Compress
Elevate
Don't place ice directly on the sprain. Wrap it in a towel or cloth and keep on the sprain or wound for 15-20 minutes at a time with 5 minute intervals of no ice*


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## Emerald (Jun 14, 2010)

11. Never give liquids if there is suspected abdominal damage... aka after car accidents and possible gut shots.. You'd be amazed how many folks give something to drink to people when they might have internal damage.


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## Nathan_Hughes (Aug 23, 2010)

Great post and good advice, thanks for reminding us


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