Injury aftercare

Blister
Change the dressing at least daily or whenever it becomes wet or dirty. Care should be taken to keep the feet as clean as possible at all times. Use soap and water for cleansing. If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape. These supplies are generally available at pharmacies.

Seek medical attention if any signs of infection develop:
 * Increased redness, pain, swelling or warmth.
 * Red streaking of the surrounding skin.
 * Pus draining from area (It's not pus if it has been less than a day.)
 * Tender lumps or swelling in your armpit, groin, or neck.
 * Foul odor from the area.
 * Generalized chills or fever over 99.6 degrees F.
 * Not healing well within 1 to 2 weeks.

A tetanus booster shot is recommended for anyone who has gotten dirt in a break in their skin (like a broken blister) and has not had a tetanus shot in the last 8-10 years. See your healthcare worker.

Follow-up with regular healthcare worker.

Preventing future blisters:

Whenever possible always keep feet clean and dry. Ensure boots are broken in for a good fit. Wear clean socks that also fit properly. Consider wearing thin liner socks (polypropylene or polyester) under heavier socks. Gloves can be worn on the hands to decrease friction as well.

As soon as you feel a hot spot developing, stop and apply a simple piece of tape placed directly over the hot spot. This will generally eliminate the friction that's causing the blister. You can also use Spenco 2nd skin, an inert breathable gel composed of 4% polyethelene oxide in water. It comes between two sheets of cellophane ans feels like the consistency of snot. For a hot spot, one can remove one cellophane sheet, apply goopy side to flesh and secure it in place. Applied this way it is very effective at removing friction between surfaces.

Burn
Keep the burn area clean and wrapped in sterile non-adherent dressing or one of the so-called "smart" dressings such as Spenco 2nd Skin or Spyroflex wound dressings. Use as directed. Change dressing daily.

Before daily dressing change, soak area in a tub or use lukewarm plain water compresses once a day. You may add 2 tablespoons of powdered detergent to the tub to help soak off crusting areas.

Do not break blisters. Fluid-filled blisters protect against infection. If blisters break, wash the area with mild soap and water, then apply an antibiotic ointment.

Prop burned area higher than the rest of the body, if possible.

A tetanus booster shot is recommended for anyone with a blistering burn who has not had a tetanus shot in the last 8-10 years. See your healthcare worker.

Burns may heal with pigment changes, meaning the healed area may be a different color than the surrounding skin. Avoid re-injuring or tanning if the burns are less than a year old-- doing so may cause more extensive pigmentation changes.

Anesthetic creams or sprays are not recommended as they can provoke allergic reactions and may delay healing.

Seek medical attention if any signs of infection develop:
 * Increased redness, pain, swelling or warmth.
 * Red streaking of the surrounding skin.
 * Pus draining from area (It's not pus if it has been less than a day.)
 * Tender lumps or swelling in your armpit, groin, or neck.
 * Foul odor from the area.
 * Generalized chills or fever over 99.6 degrees F.
 * No healing in 6 days.

Notes

Additional information available from the National Burn Victim Foundation, (201) 676-7700.

Follow-up with regular healthcare worker.

Chemical weapons exposure

 * Don't panic and don't rub your eyes.
 * Flush eyes with a 50/50 solution of liquid antacid (Maalox) and water -- LAW -- or water alone.
 * Blow your nose, rinse mouth with water or LAW, spit it out.
 * Stand in fresh air, facing the wind.
 * Some people find wiping the skin with LAW brings relief.

Seek medical attention if:
 * You break out in a rash or experience persistent symptoms-- chemical weapons' effects are designed to be temporary. If you have persistent eye irritation, call an eye specialist.
 * Seek medical attention if symptoms re-appear, worsen or change.

Personal decontamination:
 * Shower in the coldest water you can stand, scrubbing vigorously with soap, being careful not to get chemicals from your hair onto your face.
 * Follow-up with regular healthcare worker.

Personal aftercare
 * Drink lots of water, eat nutritious food, get enough sleep.
 * Ask an herbalist about detoxifying herbs.

Clothing decontamination:
 * You should not enter an enclosed space wearing contaminated clothing.
 * Remove contaminated clothing and place it in sealed bag(s) until it can be disposed of or washed.
 * Tear gas-exposed clothing is best decontaminated by hanging on a clothesline on a windy day.
 * Clothing should only be washed in cold water in a well-ventilated area, ideally through several cycles with a harsh detergent soap.

Room, furniture or carpet decontamination:
 * Intensive air exchange, preferably with hot air.
 * Steam cleaning using a 5-10% baking soda in water solution.

To lessen the impact of future exposures:
 * Do not wear contact lenses.
 * Wash clothes beforehand with detergent-free soap.
 * Wash body beforehand with castille soap (like Dr. Bronners).
 * Do not put on oil-based moisturizers, make-ups or creams.
 * Try to ensure skin and clothes remain dry.
 * Minimize exposure; keep upwind.
 * Wear protective gear:
 * Water-repellant outer layer cinched at neck, ankles, wrist.
 * No exposed skin.
 * Eye protection with gas mask or sealed goggles.
 * Breathing protection with gas mask, chemical respirator or bandanna soaked in apple cider vinegar or lemon juice over mouth and nose.
 * If you experienced breathing difficulties you should avoid further exposure altogether.

Head injury

 * If you have just gotten a neck or spine injury, lay still and ask someone to hold your head still so you won't move it. Call 911.
 * If you have a head injury, get further medical care.

Aftercare
 * For a minor head injury, consider leaving the action.
 * Try not to injure the head again; multiple concussions can be fatal.
 * If you do suffer a second concussion, seek immediate medical attention.
 * If you check out OK, you should head home and return to action only after a full week of no further symptoms and a follow-up with your healthcare worker.

If you sustained a more serious head injury:

After hospital assessment, you should have a responsible person stay with you to watch for the development of serious symptoms. The first 24 hours after injury are critical, although serious after-effects can appear up to 6 months after the injury.
 * You should rest in bed the first 24 hours.
 * The person watching you should wake you every 2 hours for the first 24 hours. See the checklist below for signs they should look for.
 * They should wake you every 4 hours the second day and every 8 hours the third.
 * Don't take any non-prescribed medicine, including aspirin, for at least the first 24 hours.
 * Follow-up with your regular healthcare worker.

Seek immediate further medical attention if you:
 * Can't be awakened or aroused.
 * Start vomiting.
 * Are unable to move your arms & legs equally well on both sides.
 * Have blood or fluid dripping from ears or nose.
 * Have a temperature above 100F (37.8C).
 * Cannot breathe well or breathe in a funny pattern.
 * Develop a stiff neck.
 * Are noticed to have pupils of unequal size or shape.
 * Are noticed having convulsions.
 * Develop noticable restlessness, confusion, or disorientation.
 * Have a persistent headache

Additional information available from:

National Head Injury Foundation, 333 Turnpike Rd., Southborough, MA 01772. (800)444-6443

Sprains / strains
Rest, Ice, Compress, and Elevate the injured area. This is called RICE therapy.

Rest
 * Protect the injured joint from further injury by allowing allowing the joint to rest 1 or 2 days with the aid of a sling or crutches. After a few days, you may use the joint as pain allows.
 * After a few days, begin exercising the joint gently, without putting any weight on it. Use ice when finished with the exercises to minimize inflammation.
 * Before resuming regular activities, be sure that you have full range of motion, strength and balance in the joint with no pain or swelling with activity. Do not ignore persistent joint pain; a body part that hurts should not be used.

Ice

Apply ice to the injured joint during the first day-- separated from the skin by a thin towel. Do not apply ice directly on the skin as this may cause frostbite. Keep the ice pack on the joint up to 2 hours at a time. Continue the ice treatment at 2 hour intervals.

On the second or third day, you may continue ice treatment or switch to heat. Heat, like ice, can deaden pain and promote healing, but it can also promote inflammation. When your greatest discomfort is associated with stiffness, heat may help.

To use heat, soak the joint in hot water, or apply heat for 15 minutes every 2 hours. But beware: if any swelling develops, stay away from heat.

Compression
 * An elastic (Ace) bandage should be used only if it makes the injured part feel better.
 * Use until completely healed-- usually 6 weeks-- and always remove during sleep. The bandage should be firm, but not too tight.
 * The limb should not swell, hurt, be cooler, or be discolored beyond the bandage.
 * When wrapping the bandage start at the most distant region and work toward the trunk of the body, making each loop a little closer than the one before. Don't stretch and wrap-- just roll it on.

Elevation

Whenever possible, elevate the joint (especially while sleeping), so fluid can drain and diminish swelling.

Other aftercare recommendations
 * Anti-inflammitory medicine may also be helpful. These include Aspirin, Ibuprofin, Homeopathic Arnica, and Arnica oil. Talk with your healthcare provider before using a medicine you have not used before.
 * Seek further care if you are not improving each day after the first 48 hours
 * Follow-up with your regular healthcare provider.

Seek immediate further medical attention if:
 * Injured part gets cold or turns blue or numb.
 * Swelling or bruising increases, despite treatment.
 * Pain becomes intolerable.
 * You see redness or red streaks spreading out from the injury.
 * After 24 hours pain prevents any weight bearing on an injured ankle, or after 72 hours pain makes weight bearing difficult.

Be more cautious with knee injuries-- by 24 hours knee should look and feel relatively normal, though it may take weeks to heal.

To help prevent a recurrence we suggest:
 * Strengthen weak muscles with rehabilitative exercises.
 * Maintain good level of physical fitness and a healthy weight.
 * Wrap weak joints with support bandages before activity.
 * Do stretching exercises daily, especially before and after exercise.
 * Wear shoes that fit properly & don't have unevenly worn tread.
 * Avoid exercising when tired or in pain.
 * When running, stick to even surfaces.

Wound

 * Stop bleeding by direct pressure or elevating injured area.
 * Clean the wound well with water.
 * Cover with a dry sterile gauze pad or clean cloth.
 * Do not remove an impaled object; stabilize it in place and seek medical care.
 * For nosebleeds, pinch nose until bleeding stops.
 * For eye injuries, cover eye and seek care.

Aftercare
 * Keep the wound clean. Wash the area gently with soap and water without scrubbing as the wound heals.
 * The wound area should otherwise be kept dry.
 * Change the dressing at least daily or whenever it becomes wet or dirty.
 * If you're allergic to the adhesive used in most bandages, switch to adhesive-free dressings or sterile gauze and paper tape. These supplies are generally available at pharmacies.
 * For painless tape or Band-aid removal, you may soak the adhesive tape in nail-polish remover (applied on the outside) for a few minutes. This will dissolve the adhesive and release both the skin and hair.
 * Try not to pick at the protective scab.


 * A tetanus booster shot is recommended if you have not had one in the last 8-10 years.
 * Follow-up with your regular healthcare worker.

Seek medical attention if any signs of infection develop:
 * Increased redness, pain, swelling or warmth.
 * Red streaking of the surrounding skin.
 * Pus draining from area (It's not pus if it has been less than a day.)
 * Tender lumps or swelling in your armpit, groin, or neck.
 * Foul odor from the area.
 * Generalized chills or fever over 99.6 degrees F.
 * Not healing well within 1 to 2 weeks.

Seek further medical care for:
 * Any animal bites (including human bites).
 * Any cuts to the chest, back, abdomen, face or hands, unless very small and shallow.
 * Any cuts that can't be fully cleaned of debris.
 * Any deep puncture wounds.
 * Any numbness, weakness, inability to move beyond wound.
 * Any wound requiring stitches-- if it otherwise cannot be closed, the cut is deep (you may be able to see a white fatty layer), has jagged or bruised edges or flaps of skin, or if it is located in an area (like on a joint) where the edges may be pulled apart. Stitches are accepted best if placed within 8 hours of injury. Any cut that might need suturing should be seen as soon as possible.

If you are immunocomprimised, have a chronic illness such as diabetes, or have prosthetic heart valves or orthopedic prostheses, you may need to be placed on prophylactic antibiotics.

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