Emergency Care for Kids

At the family reunion swim party last week, there was an accident. Cousin Hugh jumped off the diving board into the water, and on his return to the surface another cousin dove headfirst on top of him. Hugh was pulled out of the water, disoriented, glassy-eyed, and shaky. The jumper, who must have a head of steel, swam to the side with a lump on his head, upset but not seriously hurt. Ten hours later, Hugh’s parents left the emergency room with a tired but all right son.

The whole event got me thinking. I have no idea what to do in these kinds of accidents, not to mention what to do for other types of wounds. Only vague ideas on wound care and first aid float about my mind. Some professional direction on what our home first-aid kit should contain and what action should be taken for different injuries would be helpful. I got that help from our nurse friend Michael, who is also a father of four.

“If the accident knocked them out, even if they then wake up, you call 911,” explained Michael. “If the kid is crying for an extended period of time — what we call inconsolable crying — that needs to be checked out. Parents are going to know if the kid really bumped their head. Don’t wait for signs like disorientation or if the kid goes to sleep. Those are late signs of brain injury.

“Speaking of pool accidents,” Michael added, “if a child has been underwater but no one witnessed for how long and the child is pulled out and acting fine, that child still needs to be checked out to rule out ‘dry drowning.’”

We moved on to the topic of wounds and stitches. “If my child comes in with a scraped knee, I draw up saline solution with a syringe and I squirt it on the wound. Or I squirt it on gauze and scrub all the dirt out of the wound to prevent an infection problem. Then I cover the wound with gauze and tape to absorb the leaking fluids, avoid contamination, and keep it safe from prying dirty hands [Johnson & Johnson first aid gauze pads, $6.99 for 25-count of 3˝ by 3˝ at Rite Aid].”

Michael suggests gauze for small wounds to allow the air to reach the wound. For heavily oozing wounds, he suggests Telfa nonadhesive bandages, which will not stick to the wound (Curad non-stick pads with adhesive tabs, $4.99 for 20 count at Walgreens). “You don’t want to leave gauze on a heavily oozing wound because it will become part of the scab when the wound heals; it will be physically bonded to that scab.”

Michael uses Betadine ($17.99 for eight ounces at Walgreens), a brown antiseptic solution often associated with the operating room. “If I am working without gloves, I wash my hands or rub on Betadine and put some on the area around the wound. You need to do something to get in between your germs and that wound.”

For a deeper wound, “Anytime there is a flap created, get that stitched. Or if there is depth to the wound, where you are not just dealing with an abrasion...there’s a slice, or there is a deep red, meaty color that you see on both sides of the wound edges and you say, ‘That is muscle right there,’ just take the kid in. Or if the wound is in a place like the hand, which you use a lot, you want those things treated because you are going to keep opening the wound and run the risk of infection. Stitches would prevent that.”

For puncture wounds, “I try to invade minimally. If there is something still in the wound and it’s bigger than a splinter, take the kid to the doctor’s office.” But for a rusty-nail puncture with an updated immunization shot, “I would cover the wound with gauze and tape and call the doctor to run that plan by him.”

On to burns. “If it is a simple burn, you’re going to cool it down with cold water; cover it with gauze and tape only if the skin looks like it is reddened and is about to open up.” Serious burns with sloughing skin need to be examined by a professional.

I asked Michael for the protocol when a kid swallows something that could be toxic. “You need to get on the phone with poison control. Everybody should get a little refrigerator magnet that says the number for poison control because those people are experts in what they do.”

As for foreign objects in the eyes, “I like having a few syringes — without needles — around to flush dirt out of eyes. I use saline, but if you have water that you’re reasonably sure doesn’t have anything in it, I would use that.” Chlorinated pool water also does the trick, he added.

For sprains and bruises, Michael says, “Cold packs [Longs twin-pack instant-ice compress, $5.99]. I am a big fan of the four interventions for sprains: rest, ice, compression, and elevation. Ice packs that you squeeze one end and there is an endothermic reaction that goes on and it gets cold, those packs are priceless; whatever they cost, pay it. And for compression, I use an Ace bandage [$7.49 for a four-inch-wide bandage at Rite-Aid].”

Michael added one last note. “Store-bought kits often have limited supplies in them, and they’re more of a general medical-care kit, often including things like Tylenol and thermometers.” His first-aid kit is a backpack that he fills with items bought separately in bulk.