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Proper handling of injuries from animal or human bites requires experience and judgment. As a general rule, all bites that break the skin should be considered infected wounds. For this reason they should all be protected against tetanus with the appropriate tetanus toxoid booster inoculation. If previous vaccination has not been completed within the recommended period of time (usually 10 years), human tetanus antitoxin is also administered.

As soon as possible after an injury occurs, the wound should be washed thoroughly with water using the best available antiseptic soap. Careful irrigation and cleansing of the bite will remove most of the foreign substances that would otherwise produce complications or infection. When the laceration is severe or hemorrhage is present, ligatures to close the wound may be necessary. Smaller bites are best treated with the open technique, permitting them to heal by second intention. Human bites are among the most likely to become infected, because of the abundant flora of germs resident in the mouth. The lysozyme content of a dog’s saliva makes it less likely to contain virulent bacteria. But all animals, including cats, horses, dogs, and wild pets are likely to cause damage if they bite. Obviously, many of these injuries can be prevented by appropriate care in handling animals.

The bite of an animal infected with rabies virus is particularly serious. The animal usually exhibits strange behavior, and may be unsteady, foaming at the mouth, salivating, and unusually vicious. Rabies or hydrophobia, as it is sometimes called, is a viral infection of the central nervous system. Untreated, all known cases result in death. Proper rabies control requires vaccination of all pets, such as dogs and cats, with careful avoidance of untamed animals. Never pet or attempt to fondle any strange animal!

If an animal suspected of having rabies has bitten someone, the animal should be quarantined with the local health department or humane society. Within two weeks it usually becomes apparent whether rabies is present or not. If the bite is extensive or near the face, immediate inoculation of the patient with antirabies vaccine is begun. This therapy involves a series of daily injections for about two weeks. Although painful, they may be life saving. Most emergency rooms and health departments have information as to how the antirabies vaccine can be procured and administered. It is imperative to follow through with a full course of adequate protection to save the lives of such unfortunate victims.

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Two common cold injuries are frostbite and hypothermia. Taking precautions during winter weather can help you avoid them. First, never push yourself to exhaustion when exercising or working in cold weather. When you are worn out, you’re more likely to fall or suffer injury. Take hourly breaks during long treks, skiing expeditions, or work that takes you outdoors for several hours.

Second, drink plenty of water when exercising in the cold, just as you would in warm weather. You can become dehydrated if you neglect to replace fluids, especially when sweating. This reduced blood flow to the skin, which could lead to cold injury.

Remember the wind chill factor when exercising outdoors on a cold windy day. Windchill means that a calm, subfreezing weather can do less damage to skin than a warmer, windy day. When exercising outside, head into the wind first, when you are fresh and dry. If you exercise awhile and become sweaty, the dampness will magnify the windchill factor. Rain, even a cool drizzle, causes greater heat loss when you skin stays wet. Snow, even though it has a special charm and beauty, can making walking or running hazardous. During a snowstorm your ability to see is limited. Driving visibility is reduced. Wear reflective clothing when walking.

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Many thermal injuries can damage the skin. Burns include injuries caused by scalding, fire, radiation, caustic chemicals, and electricity. Although each type of burn requires individualized treatment, some generalizations are appropriate. Classification of burns is important to determine their severity, as well as to gauge the response to treatment. Traditionally, the extent is described by degrees. A first-degree burn involves the superficial layers of the skin only, and manifests itself in reddening. The most common type is sunburn. Prolonged use of heating pads or split-second exposure to a fire may also produce this self-limited, but occasionally painful type of burn.

Second degree or “partial thickness” burns also involve the skin surface or epidermis. This burn, however, transfers sufficient heat to the skin to produce blistering. These deeper types are more painful. Second degree burns of babies or small children are especially likely to become infected. If extensive, they may result in dehydration or shock.

The deepest burn, called third degree or “full thickness” involves both layers of skin, epidermis, and dermis. These may extend into the subcutaneous fat and muscle, destroying both blood vessels and nerves that supply the skin. Small full thickness burns may be produced by electricity, although more commonly they are caused by fire or chemicals. Remember that a deep partial thickness burn may become badly infected, with extension of the burn to involve all the skin layers. In contrast to first and second-degree burns that heal rapidly, the deeper full thickness variety is very slow to heal. The skin forms granulation tissue, with gradual progression to skin renewal, or grafting may be necessary.

Immediate first aid in the case of burns requires the application of cold. Often a potential third degree burn can be converted to a second degree or a second degree to a first-degree burn by the immediate use of ice or other application of cold to counteract the thermal injury. This should be prolonged for thirty to sixty minutes, unless the burn is extensive enough to necessitate immediate emergency medical care.

A second way to classify burns is according to the extent of skin involvement. The “rule of nines” has commonly been used to approximate the burn area. The accompanying diagram helps illustrate how these burned areas can be calculated. Because of the ever-present danger of contracture or scarring, burns involving the face or hands are especially serious.

Unless superficial, most burns can be treated like abrasions, with appropriate cleansing and protection against infection. Sterile dressings can be used to relieve pain and prevent the entrance of germs. Small burns are more amenable to the “open technique” than are extensive injuries. In this approach, the burn is cleansed and left open to the air to dry. Rapid formation of a crust seals off the burn, functioning like a scab to prevent infection while healing occurs beneath.

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You may wonder why I would seem so bold to even suggest fracture treatment in a home-like setting. The reasons are twofold. First, many are completely unable to afford the expenses of emergency room care or the services of an orthopedist today. Second, many fractures occur in a remote rural setting in countries where medical services are not available. Therefore, it is advisable to know some of the basic principles of diagnosis and management, not only to alleviate acute suffering, but also to prevent residual deformity as the fractured bone heals.

Fractures of the bones may be classified in several ways. The greenstick fracture is one in which only a portion of the bone is broken, leaving the major segment intact. This is more typically seen in children, since their bones are soft and still growing. Perfect diagnosis can only be obtained with x-ray. The closed fracture, formerly called simple fracture, is one in which the skin is not broken, and the bone is fractured in only one place. No other fragments are seen, and displacement is usually slight. A comminuted fracture, on the other hand, is one in which multiple fragments of the bone are present. It is usually caused by a more severe, shattering type of injury. Open (compound) fractures are those in which a sharp fragment of bone actually penetrates the skin, allowing contamination and a high risk of severe infection. Osteomyelitis of the bone is a common sequel of these extensive injuries.

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In contrast to pulled muscles (strains), sprains involve the tearing or traumatic injury of ligaments. These are strong, fibrous structures surrounding the many joints. Common areas where sprains occur are the knees, ankles, and wrists, though almost any joint can be affected. The typical “whiplash” injury of a rear-end automobile collision is also a ligamentous sprain. In reality, the entire spine is vulnerable to this type of injury.

The general characteristics of a sprain are as follows: there is acute pain, localized in the involved joint. Swelling follows, particularly if further ambulation or joint motion is continued, and the area is often held in a dependent position. When blood vessels are torn, bruising becomes apparent within hours, frequently turning the affected joint “black and blue.”

There are several important first aid measures to be used in suspected sprains. These include the immediate immobilization of the extremity, its elevation, and the application of ice packs. All of these remedies reduce the amount of swelling and pain. They also help to control bleeding within the joint.

Pain in any joint is a message from “nature” to rest the injured member. For sprained ankles, wrists, or knees, elastic bandages, crutches, and occasionally plaster casting is used for immobilization during the healing phase. Hot and cold contrast treatments, used after the first 12 to 24 hours, aid in the resolution of these inflammatory changes. They also accelerate healing and reduce pain. Unusual persistence of pain in the involved area should alert one to the possibility of fracture, which is best diagnosed with an x-ray.

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