๐ซEmergencies: what to do firstโ
Cardiac arrest often happens at home, and when someone presses on the chest in time, a higher share of people leave the hospital alive. If the person doesn't respond when you call and isn't breathing normally, start pressing; an occasional gasp does not count as normal breathing. Put your hands one on top of the other and press hard on the chest, and have a bystander call 120 (China's ambulance number) and find an AED (automated external defibrillator).
- High value
- Evidence A
- Buys life
๐ฆฏEmergencies: what to do firstโ
This approach is mainly for older people in your own family and people you know. First crouch down and call to them, and check whether they are breathing normally. If they don't respond and aren't breathing normally, start chest compressions as in ยง13.1 (press hard on the chest). If they are breathing normally, still don't pick them up: they may have fallen because of a stroke or a faint first, and forcing them up can make it worse. Ask whether they remember how they fell. If their back or lower back hurts or it looks like a fracture, never move them, and call 120 where they are.
- High value
- Evidence B
- Buys life
๐ง Emergencies: what to do firstโ
If the mouth droops, one arm is weak or speech is slurred, call 120 (China's ambulance number) at once. If a stroke can be treated with a drug that opens the blocked vessel, the earlier the treatment, the better the chance of recovery. Past 4.5 hours, or when the time of onset is unknown, don't give up on emergency care; a doctor will examine the person and decide. Note the time the symptoms started, don't give water or pills, and don't drive yourself.
- Top value
- Evidence A
- Buys life
๐ง Emergencies: what to do firstโ
If you look only at the three signs of face, arms and speech, more than one in ten strokes will be missed, because some strokes start with neither a drooping mouth nor a weak hand. If unsteadiness, double vision and a missing patch in the vision are counted too, the share missed falls to 4.4%. Sudden spinning dizziness with inability to stand, double vision, or being unable to touch your fingertip to your nose are also reasons to call 120 and note the time.
- Top value
- Evidence B
- Buys life
๐๏ธEmergencies: what to do firstโ
If one eye suddenly goes dark like a curtain being pulled down, a blood vessel at the back of the eye may be blocked, and the longer it stays blocked, the less of the retina can be saved. It is also a kind of brain ischemia, so go even if it clears up in a few minutes. When minor strokes and transient ischemic attacks were switched to same-day evaluation and same-day treatment, the share having another stroke within 90 days fell from 10.3% to 2.1%. Go the same day to an emergency room with a stroke center, and don't wait until the next day.
- High value
- Evidence B
- Buys life
๐๏ธEmergencies: what to do firstโ
This may be an acute attack of glaucoma. The fluid in the eye can't drain, the eye pressure shoots up, and it damages the optic nerve that connects to the brain. The longer it is left, the greater the chance of being left unable to see. During the Wuhan lockdown, patients waited an average of 241 hours before being treated, and 21.87% went blind. In the same period the next year, with no lockdown, they waited an average of 121 hours, and 7.84% went blind.
- High value
- Evidence B
- Buys life
๐ซEmergencies: what to do firstโ
If there is pressing pain, tightness or squeezing in the chest that lasts more than 15 minutes without easing, call 120 (China's ambulance number). If the pain is severe, or comes with cold sweat or shortness of breath, call after just a few minutes of pain. Among those whose blocked vessel was opened within 55 minutes of reaching the hospital, 2.8% died within 30 days. Among those who took longer than 55 minutes, 9.7% did. Don't drive yourself to the hospital.
- Top value
- Evidence B
- Buys life
๐ฉธEmergencies: what to do firstโ
If a tearing pain moves from the chest to the back and down to the lower back, say directly when you call 120 (China's ambulance number): "it feels like tearing, and the pain is moving downward." A type A dissection treated with medicine only, with no surgery, has a death rate of 58% in hospital. Its treatment is different from a heart attack's, and the doctor will only check for it if they think of it first. If the blood pressure differs a lot between the two arms, or the pulse can't be felt on one side, say that too.
- Top value
- Evidence B
- Buys life
๐Emergencies: what to do firstโ
What to look at is how fast the pain reaches its worst. Of severe headaches that peak within an hour, about 6% are a ruptured blood vessel on the surface of the brain. If you are 40 or older, have neck pain or stiffness, were seen to faint, the headache began during exertion, it came on like an instant explosion, or you can't bend your neck forward, then any one of these means going to the emergency room for a head CT. Most people who go are fine, but if it is missed, there may be another bleed.
- High value
- Evidence A
- Buys life
๐ฉปEmergencies: what to do firstโ
After an older person bumps their head, blood usually collects only by the third week. The knock is often only a minor bump, and more than half of patients can't say they were ever injured. After surgery for this illness, the recurrence rate can reach 33% and the death rate can reach 32%. If you find an older person suddenly confused, floating when they walk, always wanting to sleep, or with one weak hand, first go back and ask whether they hit their head in the last two or three months, and then get a CT.
- High value
- Evidence B
- Buys life
- For: Elderly relative at home, Age 60+
๐ฉธEmergencies: what to do firstโ
If one leg suddenly swells, is clearly thicker than the other and hurts when pressed, get a leg vein ultrasound soon. If there is also sudden shortness of breath or chest pain, call 120 (China's ambulance number) straight away. Among people diagnosed with a pulmonary embolism, 17.4% died within 3 months. Sitting in a car or plane for more than 4 hours roughly doubles the risk, so get up and walk around every so often. If you have risk factors for blood clots, ask your doctor before you leave whether to wear compression stockings.
- High value
- Evidence B
- Buys life
๐ฉนEmergencies: what to do firstโ
First press hard with your hand or clothing. If you can't stop the bleeding on a limb, put on a tourniquet, then call 120 (China's ambulance number), and once it is on, don't loosen it. Among wounded soldiers, nine in ten lived when the tourniquet went on before shock, and only one in ten when it went on after shock; all 5 who needed one and didn't get it died. Put it on above the wound, twist until the bleeding stops, and note the time. Don't use shoelaces or rope instead. On the neck and the trunk you can only press, not tie.
- High value
- Evidence A
- Buys life
๐Emergencies: what to do firstโ
Once rabies sets in, the death rate is almost 100%, so neither rinsing nor the vaccine can be skipped after a bite. First rinse with soap and running water, alternating, for 15 minutes, and get the vaccine the same day. A bite that goes through the skin, or a licked area where the skin is broken, is a Category III exposure, and you also need a passive immunization product. "It's a pet and has had its shots" does not change what you do: the category is set by the wound, not by where the dog came from.
- High value
- Evidence A
- Buys life
๐ฐEmergencies: what to do firstโ
Children who ran cool water over the injury for a full 20 minutes within 3 hours of getting hurt were less likely to need a skin graft later. Use cool water, not ice water, because ice makes the injury worse. If clothing is stuck to the wound, don't tear it off. After rinsing, cover it with a clean cloth and go to the hospital. Don't put on toothpaste, soy sauce, sesame oil or flour. If you only remember after a while, rinsing within 3 hours still helps.
- Top value
- Evidence A
- Buys life
๐จEmergencies: what to do firstโ
If a rash suddenly spreads over the body together with trouble breathing or dizziness, treat it as anaphylaxis (a severe allergic reaction). Call 120 (China's ambulance number) at once and say directly "suspected anaphylaxis," so the ambulance brings epinephrine (adrenaline). Allergy pills and steroids work slowly and can't replace epinephrine. If you have had a severe allergic reaction once, ask a doctor whether they can prescribe an auto-injector pen, and inject into the middle of the outer thigh, which can be done through trousers that are not thick.
- Top value
- Evidence B
- Buys life
๐ก๏ธEmergencies: what to do firstโ
Move hard objects away from around them, lay them on their side with the mouth facing down, and watch the clock to note the time. Don't hold them down, and don't put anything in the mouth, because that only injures the teeth and jaw. Call an ambulance if it goes on for more than 5 minutes, if it is their first seizure, or if the person can't be woken afterward. Do the same if a child has a seizure with a high fever; don't take the child's clothes off and don't cool the child by sponging with cold water.
- High value
- Evidence B
- Buys life
๐ฌEmergencies: what to do firstโ
First have them take 15 grams of sugar; sugar cubes or a small carton of juice will do. Test again after 15 minutes, and if it is still low, do it once more. A blood sugar below 3.0 mmol/L is the level medicine takes seriously as low blood sugar. When it reaches the point where someone else has to help, it can be fatal. Don't feed a person who is not fully conscious even one mouthful, because it can go down the windpipe. Call 120 (China's ambulance number) directly.
- Top value
- Evidence A
- Buys life
โกEmergencies: what to do firstโ
First cut the power, or push the source away with a dry wooden stick or similar, and only then touch the person. If you grab them with your bare hands, one victim becomes two. Once they are free of the source, if they aren't breathing normally, start pressing right away as in ยง13.1 (press hard on the chest), and don't hold back because it is an electrical injury. For a downed high-voltage line or near power equipment, don't handle it yourself; stay well back and wait for the power company to cut the power.
- Top value
- Evidence B
- Buys life
๐จEmergencies: what to do firstโ
If the alarm sounds, or a whole room of people have headaches, nausea and dizziness at the same time, first take everyone outdoors, then make the call. Don't stay inside looking for the cause, and don't go back to turn off a valve. The symptoms look like a cold, and "getting better once you go outside" is the strongest hint. In 2018, China reported 11,523 deaths from carbon monoxide poisoning, the most in winter; in the three winter months about 70% died at home.
- Top value
- Evidence B
- Buys life
๐งชEmergencies: what to do firstโ
If someone swallows cleaner, pesticide or medicine, don't make them vomit; vomiting can injure the throat and can also make them choke. If someone swallowed a strong acid or alkali cleaner, the Chinese CDC says to first have them drink a moderate amount of milk or egg white, then take the bottle and go to the hospital at once. If it splashes on the skin or into the eyes, rinse with plenty of water for at least 15 minutes, and for the eyes hold the lids open while rinsing and don't rub. Mixing disinfectant with toilet cleaner makes chlorine gas.
- Top value
- Evidence B
- Buys life
๐ฟEmergencies: what to do firstโ
Three steps. Step one, take off the soaked clothes, shoes and socks at once; the places where clothing traps the chemical are the most badly hurt. Step two, rinse with plenty of room-temperature running water, not hot water, for at least 15 minutes for both skin and eyes. For wounds on the skin, the Hunan Provincial Department of Emergency Management (ๆนๅ็ๅบๆฅ็ฎก็ๅ
) gives 20 to 30 minutes, so go by the longer one. Step three, for the eyes, hold the lids open while rinsing, and go straight to an eye department afterward.
- Top value
- Evidence B
- Buys life
๐ก๏ธEmergencies: what to do firstโ
Skin that is hot and red, slurred speech and confusion are heat stroke. Body temperature can rise above 41 โ within 10 to 15 minutes, and the death rate of severe cases is very high. At once move to a cool, ventilated place, take off the clothing, cool with cold water and wet towels, and call 120 (China's ambulance number) at the same time. If the person is not fully conscious, don't give even a sip of water, because it can go down the windpipe.
- Top value
- Evidence B
- Buys life
๐ฅคEmergencies: what to do firstโ
Only a person who is awake should drink. Give cool light salt water or a sports drink in small amounts, often, 500 to 1,000 milliliters an hour. No alcohol and no high-sugar drinks, which make the body lose more water. Cool the person first, then replace fluid; if the person is not fully conscious or speech is slurred, don't give even a sip.
- High value
- Evidence B
- Buys life
๐งฏEmergencies: what to do firstโ
Get down on the floor and crawl toward the exit under the smoke. Before opening a door, feel the handle and the door itself, and if it is hot or smoke is coming through the gap, don't open that door and take the second way. Open a door slowly, and if thick smoke comes, shut it again at once. Take the stairs and not the elevator. Once you are out, don't go back for belongings. If your clothes catch fire, stop, drop and roll, and cover your face with your hands.
- High value
- Evidence B
- Buys life
๐Emergencies: what to do firstโ
First shout for people and dial 110/120 (China's police and ambulance numbers), hold out a pole or throw something that floats from the shore, and don't go into the water yourself. Once the person is out of the water, if they don't respond and aren't breathing normally, start CPR at once. People who are trained should give both chest compressions and rescue breaths. If you don't know how, can't or are unwilling to give breaths, keep pressing the chest and follow the emergency dispatcher's instructions.
- High value
- Evidence C
- Buys life
๐ซEmergencies: what to do firstโ
First ask "are you choking, can you speak?" If they can still cough and make sound, let them cough on their own. If someone aged 1 or over can't speak, stand behind them and give 5 back blows followed by 5 abdominal thrusts; for pregnant women and very heavy people, thrust on the chest instead. Repeat until the object comes out or the person collapses. If they collapse, start CPR and have someone call the emergency number at the same time. Don't put your fingers in the mouth to dig for something you can't see.
- Top value
- Evidence B
- Buys life
๐งญEmergencies: what to do firstโ
Stay where you are or by the vehicle, since the vehicle is your biggest shade. The order is: if there is signal, send your position first and then call โ get shade and keep warm โ conserve water โ don't wander โ signal with a mirror, smoke and three fires. Before you go in, tell someone your route, destination, return date, and vehicle model and plate number.
- Moderate value
- Evidence C
- Buys life
๐งฃEmergencies: what to do firstโ
A body temperature below 35โ is hypothermia, and the person shivers, slurs speech, walks unsteadily and can't think clearly. Change out of wet clothes, wrap the person in a foil blanket or dry clothes, and warm the trunk first, not the hands and feet first. Give hot sweet drinks and no alcohol, because alcohol suppresses shivering. If the person doesn't respond when you call and isn't breathing normally, do CPR as in ยง13.1 (press hard on the chest).
- High value
- Evidence B
- Buys life
๐Emergencies: what to do firstโ
Sit down and keep still, and immobilize the bitten limb. First take off rings and watches, so they don't cut in when the limb swells. Get to a hospital with antivenom as quickly as you can; antivenom is the most effective way to prevent or reverse most of the venom's effects. Don't cut the wound open, don't suck it with the mouth, don't apply ice, don't rub it, don't tie it with a cord, and don't walk around. If you can photograph the snake, do so, and don't try to catch it.
- High value
- Evidence B
- Buys life
๐๏ธEmergencies: what to do firstโ
First see what kind of building you are in. In a building built to seismic code, where you would have to go down stairs and through a lobby to get out, take cover in place: protect your head and neck, get under a sturdy table, and hold the table legs tight. In a single-story house, an old brick house or a self-built house with no seismic design, if the door is just a few steps away, go out. In every case, don't jump from a window, don't take the elevator, and don't go down stairs while the shaking goes on.
- Top value
- Evidence B
- Buys life
- Disputed
๐ปEmergencies: what to do firstโ
Don't run: a bear runs like a racehorse uphill and downhill. Don't climb a tree either, since both black bears and brown bears climb. Stand still, keep talking to it in a low voice, and when it stops moving, turn sideways and back away slowly. If a brown bear charges, drop to the ground and play dead, with your hands clasped behind your neck and your legs spread. If a black bear charges, don't play dead: run to a car or a house, and if you can't get away, fight back with whatever is at hand. For a bite or scratch from a dog, rinse and get the shots as in ยง13.13.
- Moderate value
- Evidence B
- Buys life
โ๏ธEmergencies: what to do firstโ
Within range of a thunderstorm, nowhere outdoors is safe. Get into a hard-topped vehicle or a building. Convertibles, motorcycles, tents, pavilions, under a tree and under a projecting rock do not count. Stay away from open ground, ridges and summits, lone big trees, water and iron railings. If a group can't get away, spread out and stand apart. Retreat as soon as you hear thunder, and it is safe only 30 minutes after the last thunder.
- High value
- Evidence B
- Buys life
โฐ๏ธEmergencies: what to do firstโ
What counts is how high you sleep, not how high you went during the day. Sleeping above 2,450 meters carries a risk of altitude sickness. Above 3,000 meters, raise the altitude you sleep at by no more than 500 meters per night, and allow one extra day for acclimatization for every 1,000 meters gained. If you get a headache with nausea, don't sleep any higher; if it gets worse after rest, go down. If you have an unsteady walk or shortness of breath even at rest, going down and oxygen work better than medicine.
- High value
- Evidence A
- Buys life
๐ท๏ธEmergencies: what to do firstโ
Grip the tick's head with pointed tweezers close to the skin, and pull it straight out steadily. Don't put oil on it, don't burn it, and don't twist it, because that stirs it up to squeeze fluid carrying germs into the skin, and also easily leaves the mouthparts in the flesh. After removing it, note the date. If you get a fever, a rash or fatigue over the next few weeks, tell the doctor on your own that you were bitten by a tick.
- Moderate value
- Evidence B
- Buys life
๐ซEmergencies: what to do firstโ
Every microbe that can make you sick through drinking water is killed within seconds at boiling temperature. A further minute at a rolling boil is only a margin in case you misjudged, and you don't need to boil longer because of altitude. If you can't boil, use a filter or disinfecting tablets, but each of these has germs it does not cover, so boil if you can. A clear-looking stream can carry parasites just the same.
- High value
- Evidence B
- Buys life
๐ก๏ธEmergencies: what to do firstโ
When you are stopped face to face and your personal safety is threatened, save your life first; don't risk a fight or a chase over money. After the other person leaves with the money, recovering the property may still count as lawful self-defense, but that depends on the circumstances and the means. Once you are away, note his build, accent, license plate and direction of escape, and call 110 (China's police number).
- Moderate value
- Evidence C
- Buys life
๐ถEmergencies: what to do firstโ
The moment you lay a hand on anyone, breaking up a fight turns into taking part in it, so what to do is back away and leave. Actively taking part in a gang fight (่ไผๆๆฎด) is punished by up to 3 years, and by 3 to 10 years if many people are involved, the fight disrupts public order seriously on a road, or weapons are used. If you want to report it, move to a safe distance and dial 110 (China's police number), and say clearly where it is, how many people, whether anyone has knives or sticks, and whether anyone is lying still.
- Moderate value
- Evidence B
- Keeps you free
๐Emergencies: what to do firstโ
If you suspect you may have been exposed to HIV, 72 hours is a hard line, and it is best to take the first dose within 2 hours. The drugs must be taken for 28 days in a row. After 72 hours this route is gone, so don't wait until the next day to decide.
- Moderate value
- Evidence B
- Buys life
๐ฉนEmergencies: what to do firstโ
Pulling it out can cause heavy bleeding, and also makes it harder for the doctor to tell how deep the injury is. What to do: call 120 (China's ambulance number), press around the object with your hand or a dressing to stop the bleeding, and pad around the object to keep it steady and stop it from moving. If organs are showing through a wound in the belly, don't push them back in; cover them with a clean, damp dressing. If a chest wound is bubbling, don't seal it tightly with plastic sheeting, because sealing it can collapse the lung.
- High value
- Evidence B
- Buys life
๐ฆดEmergencies: what to do firstโ
Treat any injury to a hand or foot as a fracture first; being able to stand and move does not rule it out. Keep the injured part still, hold it in place by hand or support it in place with a stiff board, and use a cold pack for no more than 20 minutes at a time. Don't try to straighten it yourself, and if bone has pushed through the skin, stop the bleeding first and don't push it back. An X-ray can miss a fracture. If the film looks normal but the doctor still suspects a fracture or a ligament injury, follow the doctor's advice to recheck or get an MRI.
- High value
- Evidence B
- Buys life
๐ก๏ธEmergencies: what to do firstโ
The traces left on your body, on your clothes and in the room are the most important evidence for identifying the other person. So before the medical exam try not to shower, and don't wash your clothes or tidy the room, and call 110 (China's police number) as early as you can. Emergency contraceptive pills are available at pharmacies, and the sooner you take them the better they work. Go to a hospital within 72 hours and let the doctor decide whether you should take the preventive HIV drugs.
- Moderate value
- Evidence B
- Keeps you free
๐ถEmergencies: what to do firstโ
If the baby can still cough and cry out, let the baby cough on their own and stay beside them watching. If the baby can't make a sound and the face is turning purple, have someone call 120 (China's ambulance number), lay the baby face down along your forearm, and give 5 blows with the heel of your hand between the two shoulder blades. If it hasn't come out, turn the baby over and give 5 quick pushes in the center of the chest, and alternate the two, without pressing the belly. If the baby stops responding, switch to CPR.
- Top value
- Evidence B
- Buys life
- For: Child under 3, Pregnant or trying
๐ซEmergencies: what to do firstโ
If tapping the sole of the foot brings no response and the baby isn't breathing normally, put the phone on speaker and call 120 (China's ambulance number), and keep your hands going. Encircle the chest with both hands and press with two thumbs, or if you can't encircle it, use the heel of one hand, pressing down about 4 centimeters, about 2 times a second. After every 30 pushes, cover the child's mouth and nose with your mouth and give 2 breaths. A baby's heart most often stops because of not being able to breathe, and more survive when the CPR includes breaths.
- High value
- Evidence B
- Buys life
- For: Child under 3, Pregnant or trying
๐Emergencies: what to do firstโ
A button battery stuck in the esophagus can cause a serious burn in as little as 2 hours, and the child may look fine at first. Two or more magnetic beads will attract each other through the intestinal wall and can press a hole through the bowel. If you suspect your child swallowed one, go to the hospital for an X-ray right away; don't make the child vomit, don't wait for it to pass on its own, and don't wait for symptoms before going.
- Top value
- Evidence B
- Buys life
- For: Child under 3, Child aged 3โ18
๐บEmergencies: what to do firstโ
A person who is drunk enough to fall asleep can choke to death on their own vomit, or their breathing can slowly stop. Lay them on their side, have someone stay with them the whole time, and don't leave them to sleep alone in a room. If they can't be woken, their breathing becomes slow or irregular, they have seizures, or their skin turns cold and bluish, call 120. Don't pour coffee into them, don't give a cold shower, and don't dig at their throat to make them vomit.
- High value
- Evidence B
- Buys life
๐ฉนEmergencies: what to do firstโ
First press the wound with your hand to stop the bleeding, and call 120. Wrap the severed part in damp clean gauze, put it in a sealed bag, and put the bag in ice water; it should not touch ice directly or be soaked in water. Without cooling, a severed finger can wait only about 4 to 6 hours. More than 80% of reattached fingers survive.
- High value
- Evidence B
- Buys life
๐ฆทEmergencies: what to do firstโ
Hold the tooth by the crown and don't touch the root. If it is dirty, rinse it gently with milk or saline. If you can put it back in its place, do so, and bite on a clean cloth. If you can't, soak it in milk and see a dentist right away; don't wrap it dry in a tissue. Of teeth put back on the spot, about 20% later fuse to the bone at the root; of teeth left dry for an hour or more, more than 80% do. Don't put a baby tooth back.
- High value
- Evidence B
- Buys life
