To preserve the limb, wash it gently; wrap it in a clean, moist cloth; pack it in a watertight material; and keep it cool.
8 Dress the stump.
Coat the end of the stump with any type of available antibiotic ointment (examples include bacitracin, polymyxin, and mupirocin). Then tightly cover the end of the stump with clean cloth or gauze. Elastic strapping works well to hold the dressing onto the stump end. The tighter the dressing, the less the chance of sustained bleeding.
9 Elevate the stump end as high as possible to allow gravity to assist in slowing further bleeding.
10 Put an ice pack over the dressing.
11 Be prepared to apply and tighten a tourniquet again, should heavy bleeding resume.
12 Treat pain and shock from blood loss.
Use any available pain medication to treat pain from the injury. To treat shock, give the victim animal meat or a liquid containing salt (such as chicken soup). These will help to restore plasma and hemoglobin.
How to Preserve the Severed Limb
1 Gently wash the severed limb with water.
2 Wrap the limb in a moist, clean cloth.
3 Wrap the limb again in watertight material (such as a plastic bag).
4 Keep the limb cold.
Do not freeze the limb. Freezing will destroy tissue. Use a cooler full of ice or a refrigerator.
5 Get to a hospital immediately.
A limb saved in this manner can remain viable for reattachment for up to six hours.
WARNING!
Traumatic amputation of a limb is not necessarily a fatal injury. In order of severity, the immediate problems that you must deal with are rapid severe arterial bleeding; slower bleeding from cut veins; pain; and infection. Only severe bleeding carries an immediate, life-threatening risk, with the possibility of death in minutes.
Submerging a severed limb in water may cause damage that could hinder its reattachment. You can, however, place it in a watertight container and then submerge that in a river or lake to keep the limb cool.
HOW TO PERFORM A TRACHEOTOMY
What You Will Need
A first aid kit, if available.
A razor blade or very sharp knife.
A straw (two would be better) or a ballpoint pen with the inside (ink-filled tube) removed. If neither a straw nor a pen is available, use stiff paper or cardboard rolled into a tube. Good first aid kits may contain “trache” tubes.
There will not be time for sterilization of your tools, so do not bother; infection is the least of your worries at this point.
How to Proceed
1 Find the person’s Adam’s apple (thyroid cartilage).
2 Move your finger about one inch down the neck until you feel another bulge.
This is the cricoid cartilage. The indentation between the two is the cricothyroid membrane, where the incision will be made.
3 Take the razor blade or knife and make a half-inch horizontal incision.
The cut should be about half an inch deep. There should not be too much blood.
4 Pinch the incision open or place your finger inside the slit to open it.
5 Insert your tube in the incision, roughly one-half to one inch deep.
6 Breathe into the tube with two quick breaths.
Pause five seconds, then give one breath every five seconds.
7 You will see the chest rise, and the person should regain consciousness if you have performed the procedure correctly.
The person should be able to breathe on his own, albeit with some difficulty, until help arrives.
WARNING!
This procedure, technically called a cricothyroidotomy, should be undertaken only when a person with a throat obstruction is not able to breathe at all—no gasping sounds, no coughing—and only after you have attempted to perform the Heimlich maneuver three times without dislodging the obstruction. If possible, someone should call for paramedics while you proceed.
Find the indentation between the Adam’s apple and the cricoid cartilage.
Make a half-inch horizontal incision about one-half inch deep.
Pinch the incision or insert your finger inside the slit to open it.
Insert your tube into the incision, roughly one-half to one inch deep.
HOW TO SAVE YOURSELF IF YOU ARE HAVING A HEART ATTACK
1 Chew aspirin.
As soon as you suspect a heart attack, thoroughly chew and swallow one 325-mg aspirin tablet or four 81-mg baby aspirins. For best effect, do not swallow the aspirin whole. Heart attacks occur when the blood vessels supplying oxygen to the heart muscle become clogged. Aspirin will not stop the heart attack or remove the blockage, but it will prevent blood-clotting cells (platelets) from adding to the blockage.
2 Alert others.
If possible, tell people around you that you are having a heart attack. Instruct them to call emergency services.
3 Decrease the heart’s oxygen consumption.
Stop all activity. The faster your heart pumps, the more oxygen it uses up. Think calming thoughts about bringing your heart rate down to one beat per second. If you have a watch with a second hand, focus on the second hand. For each second, think or say quietly “heartbeat.” Repeat.
4 Increase oxygen delivery to the heart.
Lie down on the ground. Elevate your legs to keep as much blood pooled around your heart as possible; this will decrease the work your heart must do to pump blood. Open the windows to increase the room’s oxygen level. If you have access to an oxygen tank, place the nasal cannula under your nose, turn the knob to four liters (or until you feel air coming through the nasal prongs), and take deep, slow breaths through your nose and out your mouth.
5 Perform cough CPR.
Breathe, then cough every three seconds. Take a breath in through your nose, think “heartbeat, heartbeat, heartbeat,” then cough. Repeat. Coughing will deter fainting and help you stay conscious until conventional CPR can be administered.
WARNING!
Do not consume food or water. You may need a hospital procedure to “unclog” your arteries, and food or liquids in your system complicate treatment.
HOW TO USE A DEFIBRILLATOR TO RESTORE A HEARTBEAT
1 Turn on the defibrillator by pressing the green button.
Most machines will provide both visual and voice prompts.
2 First, remove the person’s shirt and jewelry, then apply the pads to the chest as shown in the diagram displayed on the machine’s LED panel.
One pad should be placed on the upper right side of the chest, one on the lower left.
3 Plug the pads into the connector.
The defibrillator will analyze the patient and determine if he needs a shock. Do not touch the patient at this time.
4 If the machine determines that a shock is needed, it will direct you—both audibly and with visual prompts—to press the orange button to deliver a shock.
Do not touch the patient after pressing the button. The machine will automatically check to see whether or not the patient needs a second shock, and if so, it will direct you to press the orange button again.
5 Check the patient’s airway, breathing, and pulse.
If there is a pulse but the patient is not breathing, begin mouth-to-mouth resuscitation. If there is no pulse, repeat the defibrillation process.
Apply one pad to the upper right of the patient’s chest, the other pad to the lower left.
WARNING!
A defibrillator should be used for a person experiencing sudden cardiac arrest (SCA), a condition where the heart’s electrical signals become confused and the heart ceases to function. A person experiencing SCA will stop breathing, the pulse will slow or stop, and consciousness will be lost.
Defibrillation is the delivery of a powerful electrical shock to the heart. (The defibrillator is the device used in movies and TV shows: two handheld pads are placed on the victim’s chest while an actor yells “Clear!”) In the past, defibrillators were very heavy and expensive, needed regular mainte
nance, and were mostly found only in hospitals. Now more portable units are available.
CHOKING
* * *
* * *
Pull your fist in and up, quickly and with strength.
Strike your date between the shoulder blades with the heel of your open hand.
HOW TO SAVE YOUR DATE FROM CHOKING
1 Speak firmly.
Keep your voice low and your sentences short. All communications should be in the imperative. Explain that you are going to perform the Heimlich maneuver.
2 Tell your date to stand up and stay put.
3 Hug your date from behind.
Put your arms around your date and make one hand into a fist.
4 Place your fist in your date’s solar plexus.
The solar plexus is the first soft spot in the center of the body just below the ribs.
5 Place your other hand, palm open, over your fist.
6 Tell your date to bend forward slightly.
If your date does not respond, push on the upper back and say, Lean forward.
7 Pull your fist in and up.
Use force and a quick motion. This will push out the residual lung gas under pressure, clearing any obstructions from the trachea.
8 Repeat steps 3 through 7 several times if choking persists.
9 After several unsuccessful attempts, instruct your date to bend over the back of a chair.
The top of the chair should be at the level of your date’s hips.
10 Strike your date between the shoulder blades with the heel of your open hand.
The blow generates gaseous pressure in a blocked airway and, with a head-down position, sometimes works when the Heimlich does not.
WARNING!
If the choking is noiseless—or if your date raises her hands to her throat—then the air passage may be completely blocked and you must proceed quickly.
If your date is coughing or gagging, you simply need to be polite, smile sympathetically, and offer water when the choking is over. Water does nothing for choking, but it gives the choker some time to regain dignity.
In most cases, the first thrust of the Heimlich maneuver will dislodge the choked item from the trachea. Once the choking is over and the blockage has been removed, there is usually no need to go to the emergency room.
HOW TO GIVE A DOG THE HEIMLICH MANEUVER
1 Check for throat obstructions.
Open the dog’s mouth and inspect the back of the throat, looking for the object causing the obstruction. If you see it, carefully remove it. If the dog is unconscious, pull the tongue forward for a better view.
2 Shake the obstruction free.
If the dog is small, pick him up and hold him by the hips with his head hanging down. For larger dogs, hold the hind legs so that the head hangs down. If this fails to dislodge the obstruction, place the dog back on the ground and proceed to the next step.
3 Place your arms around the dog’s waist.
With the dog standing or lying down, clasp your hands together around the stomach, placing them just below the last rib.
4 Compress the stomach.
Push up five times rapidly.
5 Check for an obstruction.
Sweep the dog’s mouth with your fingers to see if the object was dislodged.
6 Repeat.
If the object has not come free, strike the dog firmly between the shoulder blades with the flat side of one hand, and then do another five abdominal compressions. Alternate the back-slapping and compressions until the object is knocked free.
Place your arms around the dogs waist below the last rib and compress the stomach.
WARNING!
An unconscious dog may still bite reflexively. Be careful when sweeping the mouth. When jarring the obstruction free by striking the dog, do not hit him so hard as to injure him.
How to Perform the Heimlich Maneuver on Your Cat
Kneel and hold the cat in front of you, close to your chest. Place one forearm under the cat’s front legs and hold him up and outstretched, facing away from you. Place the fist of your other hand just below the bottom rib. Give two or three quick, firm pushes inward to force the air out of the lungs and dislodge the object.
HOW TO SAVE YOURSELF FROM CHOKING
1 Try to talk.
If you can talk or are able to vocalize in any way, or if you make a sound when coughing, your airway is not completely blocked and you are not in imminent danger of death. Keep coughing to dislodge the stuck material. If you cannot make any sounds, you will need to perform the one-person Heimlich maneuver.
2 Quickly locate a blunt object at waist level.
If you are indoors, find a chair, table, counter, or other piece of furniture; if you are outside, look for a tall tree stump, fence, ledge, or large rock.
3 Face the object.
4 Bend over the object.
Lean so that the object touches your body six inches above your navel.
5 Fall.
Let yourself drop forward hard and fast onto the object. This movement should force the air up your windpipe and eject the item that is blocking your airway.
3
Shaky Foundations
HOME AND
HEARTH
WEDDINGS
* * *
* * *
HOW TO RAISE MONEY FOR THE WEDDING
Ask family members to pay for specific expenses.
Have numbers ready to justify costs. If you sense resistance, threaten to elope or to have the reception at a seedy nightclub. For grandparents, offer upgrades at the reception in exchange for funding, such as seating at a table far from the band, their food served first, or wider, cushioned seats.
Register for wedding ceremony and reception components.
Instead of a bridal registry for china, crystal, and silver, register for floral arrangements, the band, limousine service, liquor for the reception, and each course of the meal.
Hold a raffle.
Offer the guests a chance to buy tickets to win the wedding dress, a ride in the limo, or a chance to join the honeymoon.
Wash guests’ cars.
Hire a student at a low hourly rate to sell expensive car washes to the guests as they attend the ceremony and reception.
Sell your belongings on Internet auction sites.
Check to see which items you’ve registered for have been bought, or estimate which items you are sure to receive, and sell them online. The buyer will send payment, and, after the wedding, you send the sold item.
Procure sponsors.
Strike a deal with a local company. Agree to place its logo on the invitation, wedding dress, tuxedo, or cake. Have the bandleader announce each song with, “This song has been brought to you by the good people at [name of company].” Hang company banners around the altar and behind the bandstand. Allow the company to set up a kiosk at the ceremony and reception site to dispense information, key chains, and other swag.
Sell incentive packages to investors.
Offer a percentage of wedding gifts, naming rights to kids, occasional dinners at your home, an invitation to the wedding (with preferred seating), the first dance with the bride/groom, and, for enough money, the opportunity to give away the bride.
Procure sponsors to help defray costs.
HOW TO TREAT A PANIC ATTACK
1 Realize that you’re panicking.
Panic begets panic. Do not panic about panicking. Tell yourself that you are not dying or going crazy, but experiencing an anxiety attack. This awareness will prevent the attack from escalating.
2 Loosen your clothes.
Do not tear off your dress or jacket. Open a few buttons; lower a zipper.
3 Control your breathing.
Prevent hyperventilation by slowing your breathing.
Breathe into a paper bag to restore a balance of oxygen and carbon dioxide in your lungs.
4 Distract yourself.
Focus on a physical object in the room. While breathing into the bag, close y
our eyes and try to recall the location and colors of all the objects in the room.
5 Act natural.
Open your eyes. Stop using the bag. Refasten zippers and buttons. Walk. Try to smile. Tell yourself it’s over and everything is fine.
6 Resume your activities.
BE AWARE!
An attack usually lasts between 15 and 30 minutes. Symptoms include pounding heart, sweating, dilated pupils, trembling, dry mouth, shortness of breath or sensation of being smothered, feelings of being choked, chest pain, nausea, dizziness, sense of being detached from oneself, and fear of losing control or going crazy.
Knowing that you can conquer the attacks will sharply reduce their occurrence. Conversely, knowing that you are prey to attacks and cannot control them may sharply increase their occurrence.
Control your breathing.
HOW TO AVOID A NERVOUS BREAKDOWN BEFORE THE WEDDING
Ignore minor irritations.
Avoid driving at rush hour, upgrading your computer software, dealing with a governmental agency, thinking about your job, rooting for any sports team, undertaking a plumbing project, or listening to the local news.
Ultimate Worst-Case Scenario Survival Handbook Page 10
