
First Aid for Self-Injury

     NOTE: These first-aid tips are taken from the Red Cross guide to
     first aid and from personal experience. I am not a doctor and,
     although this page was checked over by a registered nurse, I am not
     liable for any damage claimed to result from this information. In
     all cases of serious injury, seek medical attention. This
     information is provided as a service only.
     
   The most important thing, and the hardest to remember when dealing
   with the consequences of self-injury, is to refrain from judging
   yourself. Do NOT invalidate yourself. You're a human being who made a
   mistake and did something you'd rather not have done, just like
   thousands of other human beings. The fact that most people don't
   understand self-injury does not make you bad or evil or hopeless or
   stupid; it makes you misunderstood. Accept this and move on. Don't
   deny yourself medical attention you may vitally need.
   
   Sometimes the results of self-injury can be safely treated at home.
   However, if you show symptoms of infection or your self-care doesn't
   seem to be adequately healing the wound, do NOT hesitate to seek
   professional medical attention. It can be annoying trying to explain
   what's happened to a doctor, but it's not worth dying to avoid
   embarrassment.
   
Shock

   Severe cuts and burns can cause your body to go into physiological
   shock. Fluid loss causes the body to reduce blood flow to the
   extremities in order to protect vital organ systems. Basically, your
   body starts shutting down -- untreated shock can kill you.
   
  Symptoms of shock
  
     * restlessness/irritability
     * altered consciousness (dizziness, feeling faint, nausea)
     * pale, clammy, moist skin
     * rapid breathing
     * rapid pulse
       
  Treating shock
  
     * Call 911. Shock is a serious condition requiring immediate medical
       treatment. It can kill.
     * Have the victim lie down
     * Control external [1]bleeding
     * Keep victim comfortable to reduce the stress on body systems
     * Help maintain body temperature; if victim seems cold, cover
       him/her with a blanket
     * Reassure victim
     * Unless head, neck, or back injuries or broken bones are suspected,
       elevate victim's legs about 12 inches
     * Don't raise victim's head
     * Give victim no food or drink, even though s/he is likely to be
       thirsty
       
Specific Wound Treatments

  Burns
  
   Critical burns that need immediate medical attention include those
   where breathing difficulty is present, where more than one body part
   is affected, or where the head, neck, hands, feet, or genitals are
   involved. All chemical, explosion, electrical, and third-degree burns,
   especially if they cover more area than the palm of your hand, should
   be evaluated by a medical professional.
   
    Immediate treatment of burns
    
     * Run cold water over burned area for 15 minutes, if possible
     * Do NOT put any creams or greases on the burned area
     * Do not pop any blisters. Cover the burn with a light gauze
       dressing
     * If blisters pop, apply a light antibiotic ointment and dress as
       above
       
   First-degree burns, those that merely redden the skin, can usually be
   treated successfully at home. Keep the area moist and covered.
   
   Second-degree burns cause reddening and blistering of the skin. If
   they are moderately large, they require medical attention.
   
   Third-degree and worse burns involve charring or whitening of the
   skin. The burn has penetrated through the entire thickness of skin
   layers. These burns should always be treated professionally; they
   often require grafting or become infected. The layer of dead skin and
   nerves is called "eschar," and the process of removing it is known as
   "debridement." Having burns debrided hurts like hell, even with drugs,
   but it can be necessary to prevent infection. Let your doctor make the
   call on whether grafts or debridement are needed.
   
   Burns are nasty, disfiguring, painful, and far more trouble than
   they're worth. If you burn yourself severely enough to require
   grafting, the surgeons will put you under general anesthesia, take an
   instrument that's kind of like a carpenter's plane or a cheese slicer,
   and peel a section of skin from an unburned part of your body to graft
   onto the damaged site. It hurts, it's boring, and if it gets infected
   you have to do it all again. And few things in life have hurt me as
   much as a healing donor site did. You don't wanna deal with it.
   
   Once more, with emphasis, if you have a bad second or a third-degree
   burn, get your ass to an emergency room. Immediately.
   
  Cuts and lacerations
  
   Most cuts, even ones a doctor might suggest stitching, can be dealt
   with at home. There are two exceptions to this:
   If you can't stop the bleeding, or
   If you're going into [2]shock.
   
  If you can't stop the bleeding
  
   If a cut won't stop bleeding, first try pressing cloths or paper
   towels (maxipads and Depends make good bandages, too) directly on top
   of the wound. On top of that, place a large object (like a balled-up
   sock), and wrap the entire thing tightly in an Ace bandage. Keep the
   wound above the level of your heart and check it in ten minutes; if
   it's still bleeding, re-wrap it and go to an emergency room. If you're
   feeling the symptoms of shock, call 911.
   
   It's important to maintain direct pressure for ten minutes without
   peeking. If you're pressing a cloth or bandage against the wound and
   the blood soaks through before ten minutes are up, just put another
   one on top of it. After you stop the bleeding, place a cold pack on
   the wound for ten minutes. Then wash with Betadine and apply an
   antibiotic ointment or spray (to keep the wound moist and minimize
   chances of infection) and a bandage. Change the bandage twice daily,
   and rotate the direction of the bandage tape to keep the skin around
   the cut from becoming too irritated. Bandages should be large enough
   that they extend an inch beyond all edges of the wound.
   
   Watch for redness or heat spreading outward from the wound; these are
   signs of an infection and should be treated by a doctor. Other signs
   of infection include swollen lymph glands, increased pain, and fever.
   If you start running a fever, go to the doctor immediately.
   
   Why bother about bandaging? Well, properly bandaged cuts heal faster
   and are less likely to scar. If the wound is small enough, the new
   Advanced Care Band-Aid is a good idea. You apply it and leave it on
   for several days as the wound heals underneath; it's made from a
   special material that turns fluids from the wound into cushioning or
   lets them evaporate. The tight seal means no bacteria can get in. If
   you choose to use a product like this, be sure to read the package
   directions. Closing the wound with Steri-Strips is also a good way to
   minimize scarring; the closer the wound edges are as they heal, the
   less scar tissue the body has to produce to join them.
   
   Drink lots of fluid to make up for any blood you've lost. If you do
   this and you're still dizzy on standing (postural hypotension -- your
   blood pressure is dropping when you stand), see your doctor. Also, if
   you lost a lot of blood or are extremely fatigued, have your blood
   hematocrit (iron levels) checked -- you might have made yourself
   anemic.
   
  Stitches
  
   When do you need stitches? The criteria most doctors use:
     * Cuts that will not stop bleeding;
     * Cuts that are more than 1/4 inch long and on the hands, face,
       feet, or genitals;
     * Cuts in the mouth that are more than 1/2 inch long;
     * Cuts elsewhere on the body that are gaping (you can see
       tissue/fat).
       
   If it's been more than 8-12 hours since the wound, most doctors won't
   stitch it. If you absolutely refuse to go to a doctor, at least get
   some Steri-Strips (or similar product; you can find them in
   pharmacies) to close the wound yourself. Wounds are stitched mainly to
   stop bleeding and to reduce scarring.
   
  From a plastic surgeon: Wound/infection treatment
  
    1. Get some Betadine ointment and Betadine solution (OTC
       povidone-iodine solution).
    2. Put the Betadine solution on the wound when fresh. Wait until the
       Betadine dries, then butterfly it closed (you can get Steri-strips
       in a pharmacy) and cover it with gauze -- this is the only time
       you put on the liquid Betadine.
    3. DON'T put anything in the fresh wound you wouldn't put in your own
       eye (no alcohol, peroxide, soap, etc.). [He says this is standard
       advice for 1st-year plastic surgery residents.]
    4. If the wound seems deep or gaping, if you see fat, or you don't
       stop bleeding soon try to go to an emergency room. It's worth the
       [possible] humiliation to know you're safe.
    5. The next day start changing the dressing 2 times a day:
          + wash it when you shower
          + pat it dry
          + smear on some Betadine ointment and cover with gauze (the
            Betadine ointment stains).
    6. If the Betadine ointment irritates you, substitute Silvadine
       (silver sulfadiazine)[prescription required in some places].
    7. If you develop a fever, or the redness around the wound starts to
       spread away from the wound or the wound gets full of pus or
       becomes very tender and red you have an infection. The treatment
       involves oral antibiotic with a culture of the germ responsible
       for the infection and possibly reopening the wound if an abscess
       is formed. If you have access to antibiotics it is possible to
       treat yourself, but a visit to the doctor is safer. The proper
       antibiotic to use is a guessing game since there are different
       organisms on different parts of the body. Putting medicine on the
       surface of the wound is off once the skin has closed.
       If the wound is still open and you are not feverish and the
       redness is within an inch of the edge, you can try Dakin's
       solution: mix 1 tablespoon of liquid Clorox in a quart of water:
       it kills staph (the most common bug). Soak gauze in it and put on
       wound, cover with dry gauze, and change 3 times a day. If
       successful in two days (redness going away, wound with much less
       pus and less pain) then continue it until it heals. If it gets
       worse on this, stop it and see an MD. Remember this advice is
       general and may not fit every person or every wound--when in doubt
       invest in the medical visit.
       
   Dr. Fischman also had this to say:
   
     Silvadine is first choice for burns. The real trouble in
     recommending Rx's for infections is that the person has to decide
     if it is "serious" and requires MD attention. The patient usually
     doesn't have the experience to make this decision safely (e.g., all
     diabetics' wounds are "serious").
     
  Bruises and sprains
  
   If a bruise or sprain has caused significant swelling and pain, if you
   can't move the affected body part, or if a joint/bone looks misplaced,
   have it evaluated by a medical professional to be sure there's no
   break. Treat bruises and sprains with the RICE formula used for sports
   injuries: Rest, Ice, Compression (an Ace bandage), Elevation.
   
  Pain
  
   For pain caused by self-injury it's best to use Tylenol; it doesn't
   thin the blood the way aspirin and NSAIDs (Advil, Aleve, etc) can. Be
   careful not to take so much that you mask any possible fever, and if
   you have severe pain persisting over many days, see your doctor.
   
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References

   1. file://localhost/usr/home/llama/Web/psych/firstaid.html#bleed
   2. file://localhost/usr/home/llama/Web/psych/firstaid.html#shock
   3. file://localhost/usr/home/llama/Web/psych/injury.html
