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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 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 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.

Check it in ten minutes; if it's still bleeding, rewrap it and go to an emergency room. If you're feeling the symptoms of shock, call 911.

If you can stop the bleeding, 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.

Watch for redness or heat spreading outward from the wound; these are signs of an infection and should be treated by a doctor. If you start running a fever, go to the doctor immediately.

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.

From a plastic surgeon:

Wound/infection treatment

Get some Betadine ointment and Betadine solution (OTC povidone-iodine solution). 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.

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.]

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.

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).

If the Betadine ointment irritates you, substitute Silvadine (silver sulfadiazine)[prescription required in some places].

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 acess 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, 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.

This information was taken from www.palace.net