‘Tis the season for outdoor living and potentially bad weather, so why not add some extra special goodies to your first aid kit? Don’t have one? Now is the time to make one. Don’t have to make it so basic, though. Buy a back pack and load up!
Besides the usual tape, pads, band aids, and ointments, more and more standard medical equipment is becoming available to the general masses for very cheap prices. Nowadays you can pack a wrist blood pressure monitor to check blood pressure, a pulse ox to read oxygen saturation, a stethoscope to hear lung sounds, and even an app for your smartphone which will take an ECG of your heart. This equipment isn’t hard to operate, but you do need to know a few tricks about how to use them and there are concerns in regards to whether the ECG app is entirely safe. The most important thing is to learn the equipment and how to read the body.
We all can do to learn a few things about our bodies – the proper way they’re supposed to operate, and what’s going on when they’re not operating properly. This is not intended, by any means, to give out medical advice, but it’s easy to educate yourself in a little first aid for yourself, your family and your community. Best and quickest way is to contact your local Red Cross for classes and click on “training and certification” in their menu. All sorts of possibilities for learning about emergencies, prep and otherwise are on this page! It’d make a great family project!
Probably the most important thing in giving aid is to recognize what is normal and what is not. Especially when dealing with children, this is very important. For instance, simply knowing something about how your heart beats and what different types of breathing mean, can really help in a trying time, especially in an emergency. Number one rule, if you’re ever concerned in any way that you’re dealing with an emergency, call 911 immediately. Then stay on the phone to give information to the dispatcher.
Simple diagnostics for pets and people
The pulse is a real good way to quickly ascertain the severity of a situation, i.e., whether a heart is beating. The pulse is the movement of blood through your veins, controlled by the beat of your heart. For the most part most people have a heart rate between 80 and 100. Extremely well-toned athletes may have rates lower than usual, and infants, children and sometimes the elderly have higher rates. An extremely slow or rapid pulse otherwise is a cause for concern. No pulse? Start CPR.
You take a pulse either on your radial artery at your wrist, or on your carotid artery on your neck. There are other places, but these two are the quickest to get to. You’ll know it’s an artery vs. a vein because an artery pulses. The radial artery (at your wrist) is better to palpate because a lot of manipulation on your carotid artery can affect your heart rate. Take your pulse by placing the fleshy tips of your first two fingers of one hand just inside your wrist below your thumb on the other, or someone else’s hand. (Guitar players or people with calloused hands, mind your callouses aren’t interfering with your ability to feel the pulse!). A pulse should feel fairly strong with a steady rhythm. Start by counting the pulse for 15 seconds and multiply by 4. Lower than 40 beats/minute is bradycardia and generally is a cause for concern (unless you’re a ripped athlete), as is a pulse over 100 beats a minute (tachycardia). If the rhythm is erratic, that is also a cause for concern. Pulses can also be described as “thready,” meaning it feels like not enough blood is coming through and is difficult to feel, or “bounding,” meaning it feels like the blood is trying to jump out of the artery. That usually means the heart is really working hard, unless you’ve just run a marathon. Palpate a pet’s pulse on their carotid, which is on their neck, under their ears. Pets generally have a higher pulse rate.
Breathing is another good way to ascertain whether an emergency exists. Rapid breathing is a worrisome sign as is very slow, or, of course, no breathing, when you’d start rescue breathing. Lightly lay a hand on a patient’s chest and, like counting a pulse, count your breaths in 15 second increments and multiply by four. Breathing should be relaxed, with deep breaths taken ever so often and mixed in with more shallow ones. Breaths should come from the chest and not the stomach. Normal rate is about 12-20 breaths per minute for an adult and 12-30 for an elderly person or a baby or child. Any obvious wheezing or whining sounds are causes for concern. Also watch to see that there are not forceful exhalations, which are obvious because the belly will be distending (popping out) with every breath. This is usually indicative that one cannot exhale fully, which means there is injury or perhaps airway collapse and is a cause for concern. Winter is an excellent time for “cold weather” or “exercise induced” asthma, where airways clamp down more due to the frigid air, or forceful air from exercise, moving in and out of the airways. If your “patient” is on inhalers, it would be a good time to use them. If you’re in a situation where someone is frantic, coach them to take deep breaths through the mouth and exhale through the nose or pursed (kissing) lips.
Capillary refill refers to how quickly and fully a capillary bed returns to pink after being pressed. In a human, you can do this by pressing on their nail bed, unless a patient is wearing nail polish. On a pet (and a nail polished person), lift up a patient’s lip and press firmly against the gums and then lift your finger off. Note how quickly the pink fills back in. If the gums are not pink in the first place, or the refill rate is very slow, that is very important, and can indicate a bleed somewhere.
Eyes should react to a light such as a flashlight beam, and should move from left to right as one. The pupils should constrict when light is shown into them. If eyes are not properly reactive to light, it could be indicative of a stroke, head injury or cardiac event.
Positioning a patient is important. Make sure the airway is open by positioning a towel behind and under the neck so the head falls slightly back, opening the airway. Lift the legs to ensure blood can get back to the heart easily. If a neck or head injury is suspected, don’t move either one.
Using over-the-counter medical equipment
Blood pressure is an important measurement to assess the heart. Blood pressure cuffs, used on the wrist, are cheap and available at just about any drug store, or grocery store for about $40.00. They are quick, fairly reliable, and easy to use. New ones have red, yellow or green lights that indicate normal vs. abnormal values. Normal adult blood pressure is around 120 over 80 mm Hg (millimeters of mercury). The top figure is the systolic pressure, which is the pressure it takes to push the blood into the ventricle. The bottom figure is the diastolic pressure, which is the minimum pressure during relaxation and dilation of the ventricles (when they are filling with blood). Increasing these values by 20 and above is indicative of pre-hypertension and/or hypertension. A value of 20 and below is indicative of hypotension, possibly poor blood circulation (unless your patient is very fit). BP cuffs will also give you a heart rate.
A piece of equipment which is essential to all respiratory therapists, and is now increasingly cheaper, is a pulse oximeter. They used to be outrageously expensive, about $300 for the ones we used, but can now be bought at WalMart for about $20. This is a great piece of equipment which will tell you how much oxygen is in your blood (should be about 98%), what your pulse is and some will indicate your pulse’s strength. The percentage that your blood is oxygenated will give you a hint about how well your patient is breathing, since your lungs oxygenate your blood. This is a righteous piece of equipment, well worth the price and so easy to use. Just clip it on to your fingertip with the nail bed under the probe (red light). I think it should be a part of any medical kit.
There are just a few caveats to keep in mind. It works by reading your blood cells for oxygen, so anything that interferes with that, like fingernail polish, or smoke inhalation is going to affect the accuracy of the readings. If you are taking your blood pressure on the same limb, when the cuff tightens on your wrist, it will affect the reading, because the blood pressure cuff is cutting off the flow of blood. To a significant extent, any disease or medication which affects hemoglobin will affect the readings. For instance, some African-Americans can have a condition called sickle cell anemia, so pulse ox readings might not be as accurate for them. There are also some other dyshemoglobins which will not read accurately – two primary ones are carboxyhemoglobin, which is what happens when you breathe carbon monoxide (in a fire, for example), or methehemoglobin (primarily inhaled chemicals), which has to do ferric oxide oxidation. Some causes are genetic, and some come from toxic sources, like some medications or other situations. When this happens, these substances block the blood cells from absorbing oxygen, so the measurement may very well be wrong.
As far as equipment is concerned, one of the most cheapest and useful things are stethoscopes. I couldn’t imagine raising a child without one. Long found draped around the necks of nearly all clinical medical personnel, stethoscopes are those tubes that your clinician uses to listen to your heart and lungs. While it almost takes a degree in cardiology to discern some of the more subtle sounds of your heart chambers, basic lung sounds are fairly easy. Stethoscopes are as close as your neighborhood medical uniform store, and are priced anywhere from $15 to hundreds of dollars, depending on the type.
Basic lung sounds are clear, increased, decreased, rales/rhonchi, wheezes and stridor. There should always be some sounds if you’re breathing, and certain parts of the lungs have more breath sounds than others. There are five lobes in the lungs. Starting at the top of the respiratory system, if you put the small part of the diaphragm (the head will pivot) on your neck, you can hear stridor if your throat is closed off in any way, such as with strep throat, a bad bronchitis or croup in children. Moving on down, and turning the diaphragm so the wider part sounds, the tops of the lungs move more air than the lower parts of the lungs. There are more breath sounds while inhaling than exhaling. Wheezing, a high keening sound, is heard when your airways are somewhat closed down with either asthma or COPD. Wheezing can be caused by very cold weather. Rhonchi or rales is what is heard when secretions are involved – that would be either a fine gurgling (rales-paper rattling sound) that is typical of congestive heart failure, or a heavy gurgling (rhonchi) typical of secretions. Pneumonia can present with either rhonchi (loose secretions) or with decreased breath sounds (consolidated secretions). The best way to learn them is to listen to them. Some great tutorials can be found on line, such as: http://www.easyauscultation.com/lung-sounds.
The natural state of the lungs is to be inflated. I say that because often times in car wrecks and other accidents, a lung can be damaged due to trauma, including projectiles. When the lung loses air, it fills the space outside the lung, which then puts pressure on the lung so it can’t fully inflate. This is called a collapsed lung or a pneumothorax, and is a real emergency. Signs of a pneumo are that the patient, if conscious, is in huge distress, really struggling for air. Another sign to look for is deviation (movement) of the trachea away from the affected lung, flaring of the nostrils, decreased blood pressure, increased heart rate, and/or a bluish color to the skin.
A new feature of some smart phones is the ability to download an app which will allow you to take an actual ECG (electrocardiogram) of your heart. One such ECG machine app, called the AliveCor, can be used with the iPhone 4 and 4s. It costs about $200. Dr. Stephen Sinatra, a highly respected and sought-after cardiologist, though, is not entirely sure about the safety of using them. On the one hand, he can see the utility in a doctor’s office, so he doesn’t have to send you to have one done, and the info is there immediately. On the other hand he has some concerns with both cell phone radiation to the heart, and that results will be misread and misinterpreted. According to Sinatra, “First off, cordless phones disturb heart rate variability. Second, holding a cell phone over the chest to check your heart’s rhythm may have the potential to throw your heart out of rhythm, or aggravate an arrhythmia you may be experiencing.” He cautions that an arrhythmia might not last long enough to send to a doctor and that one ECG rarely shows an evolving heart attack.
Now for the crème dela crème, AEDs or automatic external defibrillators. These should not be in untrained hands, however, the Red Cross believes “all Americans should be within four minutes of an AED and someone trained to use it.” So this means, if you are a rural person or live in a smaller community a bit away from a metropolis, it might be worth your while to buy one and go to the Red Cross and learn how to use it. An AED will simply: 1. tell you if a heart is out of rhythm and 2. can shock it back into rhythm (hopefully). By way of an on screen ECG tracing (electronic), you can see if a person is having any major arrthythmias such as PVCs (pre-ventricular contractions), PACs (pre-atrial contractions), or other more lethal heart rhythms. Selling for as low as $800 on line (and as much as several thousand), they are a life line in factories, coal mines, farming operations, or anyplace else an emergency crew can’t get to quickly.
Another important thing is to find out if you or anyone in your family is allergic to anything, and if they are, get and keep an Epi-pen handy – it can save lives. A person can literally suffocate in anaphylaxis, so go see the doc and get okayed. Triggers can be:
–certain medications, especially penicillin;
–foods such as peanuts, walnuts, pecans, almonds and cashews;
–wheat, fish, shellfish, milk and eggs;
–insect stings from bees, yellow jackets, wasps, hornets and fire ants.
Last but not least in outdoor fun is the possibility of a snake or spider bite. According to the website http://kysnakes.ca.uky.edu/ there are 33 species of snakes in Kentucky but only 4 are venomous. Before any outdoor excursions for either yourself and/or your family and/or friends, educate yourself and yours about what to watch out for out there. Check out this page, it’s a great one: http://www.snakesandspiders.com/kentuckys-venomous-snakes/
A final word about communing with nature – hydrate, hydrate, hydrate. Bring plenty of water along for drinking and other purposes, and enjoy your summer!
Lyn Hacker is a Lexington native raised by Appalachian parents to be not only educated but proficient in the living arts – working very hard, playing music, growing gardens, orchard management and beekeeping. The UK graduate has been a newspaper staff writer and production manager, a photography lab manager, a Thoroughbred statistics manager, a Bluegrass singer and songwriter, a registered respiratory therapist, a farmer, a Standardbred horsewoman, and a beekeeper. She lives on a farm in Sadieville.
