HOME EMERGENCY GUIDE · YOU CAN DO SO WITHOUT PUTTING YOURSELF AT RISK. DIAL 911. ACTION PLACE VICTIM IN THE RECOVERY POSITION (pp.14–15). CHECK FOR SIGNS OF INJURY. DIAL 911 OR

HOMEEMERGENCY

GUIDE

DK Publishing

HOMEEMERGENCY

GUIDE

CONTRIBUTORSDr. Vivien Armstrong • Dr. Sue Davidson • Professor Ian Davis

David Holloway • John McGowan • Tony WilkinsDavid R.Goldmannn MD FACP • Allen R.Walker MD • John Cunningham

Produced for Dorling Kindersley byCOOLING BROWN

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individual reader. The ideas, procedures and suggestions contained in this book are general and notintended as a substitute for consulting a relevant specialist in individual cases. The publisher would inany event always advise the reader to consult his or her doctor or other health professional for specificinformation on personal health matters. The publisher cannot accept any legal responsibility for any

loss or damage allegedly arising from any information or suggestion contained in this book.

First published in the United States in 2003 byDK Publishing, Inc.

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CONTENTS

Action in an emergency .................10

Resuscitation techniques ................12

Choking (adults and children)...........................22

Choking (babies under 1) .................................24

Heart attack.....................................25

Asthma attack .................................26

Shock................................................27

Anaphylactic shock .........................28

Head injury ......................................29

Stroke...............................................30

Severe bleeding...............................31

Penetrating chest wounds ............................................32

Cuts and scrapes..............................33

Splinters ...........................................34

Eye wound.......................................35

Foreign object in the eye ...............36

Chemicals in the eye .......................37 Bleeding from the mouth ..............38

Nosebleed ........................................39Emergency childbirth......................40Major seizures .................................42 Febrile seizures................................43 Broken arm......................................44 Broken leg .......................................45Spinal injuries ..................................46 Sprains and strains ..........................47Severe burns ....................................48Minor burns and scalds...................49Sunburn ...........................................50Heat exhaustion ..............................51 Heatstroke .......................................52Fainting............................................53 Hypothermia ...................................54 Frostbite...........................................55 Swallowed poisons ..........................56 Snake and spider bites....................57 Animal and tick bites.....................58

Insect and scorpion stings ...................59

First-aid equipment ........60

1

FIRST AID

How to use this section .................66Assessing symptoms (adults) ...........68Assessing symptoms (children) ..........................................70Not feeling well .............................72Fever (adults) ...................................74Fever (children) ................................76Excessive sweating .........................78Lumps and swellings ......................80Feeling faint /passing out ..............82 Headache ........................................84 Vertigo ............................................86Numbness and /or tingling ............88Facial pain.......................................90Difficulty speaking .........................91Forgetfulness or confusion............92General skin problems....................94Rash with fever ..............................96Eye pain or irritation ......................98Disturbed/impaired vision ...........100Earache .........................................102Sore throat ...................................103Hoarseness orloss of voice ..................................104Coughing (adults) ..........................106Coughing (children) .......................108Shortness of breath (adults) ...........................................110Breathing problems (children) ........................................112Wheezing......................................114Difficulty swallowing ....................115Vomiting (adults) ...........................116Vomiting (children) ........................118Abdominal pain (adults) ...........................................120Abdominal pain (women) .........................................122Abdominal pain (children) ........................................124Abdominal swelling .....................126Anal and rectal problems ............127

Diarrhea (adults)............................128Diarrhea (children) .........................130Constipation .................................132Chest pain .....................................134Palpitations...................................136Poor bladder control ....................137Painful urination ..........................138Back pain ......................................140Neck pain or stiffness....................142Arm or hand pain ........................144Leg pain ........................................145Joint pain ......................................146Swollen ankles..............................148Erectile dysfunction .....................150Testes and scrotum problems .......................................151Penis problems .............................152Breast problems ...........................154Painful menstrual periods ...........156Heavy menstrual periods .............157Abnormal vaginal bleeding........................................158Vaginal discharge.........................160Genital irritation (women) .........................................161Home medicine chest ....................162Caring for a sick person...............164

2

FAMILY ILLNESS

Planning for disaster....................220

Severe storm .................................226

Flood .............................................228

Extreme cold .................................230

Wildfire .........................................232

Hurricane ......................................234

Tornado.........................................236

Earthquake ...................................238

Volcanic eruption .........................240

Tsunami.........................................242

Post-disaster survival ....................244

Useful addresses and online listings........................250

Index .............................................253

Acknowledgments .......................256

Home safety..................................172

Yard safety ....................................178

Fires in the home .........................180

Gas leaks .......................................184

Plumbing problems .......................................186

Central-heating problems .......................................192

Air-conditioning problems .......................................194

Electrical problems .......................196

Structural problems......................200

Insects and pests...........................208

Furniture and furnishings ....................................210

Home security ...............................212

3

HOUSEHOLD EMERGENCIES

4

NATURAL DISASTERS

Knowing what to do in a medical emergency, such as when someonesuffers a heart attack, a deep chest wound, or a snake bite, could save

the victim’s life. This section tells you how to recognize importantsymptoms and give appropriate first-aid treatment in a wide range

of situations, with full details on resuscitating an unconscious person.

Action in an emergency .....................10

Resuscitation techniques .....................12

Choking (adults and children).........22

Choking (babies under 1) ...............24

Heart attack...................25

Asthma attack ...............26

Shock..............................27

Anaphylactic shock .......28

Head injury ....................29

Stroke.............................30

Severe bleeding ............31

Penetrating chest wounds ..........................32

Cuts and scrapes............33

Splinters .........................34

Eye wound.....................35

Foreign object in the eye.......................36

Chemicals in the eye.......................37 Bleeding from the mouth .....................38 Nosebleed......................39Emergency childbirth .......................40Major seizures ...............42 Febrile seizures..............43 Broken arm....................44 Broken leg .....................45Spinal injuries ................46 Sprains and strains ........47Severe burns ..................48Minor burns and scalds ......................49Sunburn .........................50Heat exhaustion ............51 Heatstroke .....................52Fainting..........................53 Hypothermia .................54 Frostbite.........................55

Swallowed poisons........56 Snake and spider bites ....................57 Animal and tick bites ........................58 Insect and scorpion stings...............59First-aid equipment ......60

1

FIRSTAID

FIRST AID

Action in an emergency10

ACTION PLAN

ACTION

ELIMINATE DANGER,OR REMOVE THEVICTIM FROMDANGER, ONLY IFYOU CAN DO SOWITHOUT PUTTINGYOURSELF AT RISK.DIAL 911.

ACTION

PLACE VICTIM IN THERECOVERY POSITION(pp.14–15). CHECKFOR SIGNS OF INJURY.DIAL 911 OR CALLEMS.

ACTION

CHECK THEVICTIM’S INJURIES(p.11) AND TREATAS APPROPRIATE.CALL FOR HELP IFNECESSARY.

Yes

No

Are you and/orthe victim inany danger?

Yes

No

Is the victimtalking to you?

Yes

No

Is the victimbreathing?

Yes

No

Dial 911 orcall EMS.

Give rescuebreaths

(pp.16–17). Arethere any signsof circulation?

START

ACTION

GIVE CPR (pp.18–20).

ACTION

CONTINUE RESCUEBREATHS.

When faced with an emergency, try to remain calm and controlled so that youcan act effectively. Before assessing the victim’s condition and carrying outthe appropriate first aid, make sure that you are not putting yourself in danger.You will not be able to help anyone else if you become a victim yourself.If possible, have someone else dial 911 while you deal with the situation.

Yes

No

Is the victimconscious?

11ACTION IN AN EMERGENCY

CALLING AN AMBULANCE

1Dial 911 • Check the victim’s breathing

before calling for help.

• If possible, send someone else tomake the call and ask him or herto confirm that help is on the way.

• If you are alone with a child whois unconscious or an adult whohas drowned, choked, or beeninjured, give rescue breaths(pp.16–17) and/or CPR (pp.18–20)for 1 minute before making the call.

• If you are alone with an adult whois not breathing and you suspect aheart attack, dial 911 immediately.

• If you have to leave a victim whois breathing, place him in therecovery position (pp.14–15).

ASSESSING A VICTIM’S INJURIES

• Deal first with any life-threateningconditions the victim may have,such as unconsciousness (p.21),breathing difficulties (p.12), orheavy loss of blood (p.31).

• Check for and treat anyother injuries.

Check the victim toassess her injuries

2Give information• Tell the ambulance dispatcher

where you are, your telephonenumber, what has happened, theage, sex, condition, and injuries ofthe victim(s), and whether anyhazards are still present, such as a fire or gasoline on the road.

3Give first aid• Give the appropriate first-aid to

the victim.

• Stay with the victim until medicalhelp arrives.

• Monitor the victim’s breathing(p.68 for an adult, p.71 for a child),pulse (p.68 for an adult, p.70 fora child), and consciousness (p.12)until the ambulance arrives.

Monitor the victim’scondition whilewaiting for theambulance

12 FIRST AID

The techniques on the following pages, used in sequence, can help maintain avictim’s oxygen supply until help arrives. Upon finding an unconscious person, you need to open and, if necessary, clear the victim’s airway so that air can enterthe lungs. If the victim is not breathing, give rescue breaths to maintain the oxygensupply, thereby sustaining the victim’s vital organs. If the victim also has nocirculation, give cardiopulmonary resuscitation (CPR) – rescue breaths with chestcompressions – to ensure that air enters the body and is circulated by the blood. An unconscious victim who is breathing should be placed in the recovery position,a secure position that keeps the airway open and the head, neck, and back aligned.

CHECKING FOR CONSCIOUSNESS (all ages)

Resuscitation techniques

1Seek reaction• Ask a simple question, or give

a simple command, such as“Open your eyes.”

• Shake an adult’s shoulders gently.

!Important• Never shake a baby or child. Instead,

gently tap the shoulder or flick thesole of the foot.

2Assess response• If the victim responds to

speech, assess whether he isalert and aware of the situationor confused and sleepy.

• If he responds to touch, assesswhether he reacts readily to yourtouch or is sluggish in response.

• If there is no reaction at all, openthe victim’s airway (p.13).

3Monitor victim• During first-aid treatment, you

will need to repeat steps 1–2every 10 minutes to check thevictim’s level of consciousness.

• Note any changes in the victim’sresponses to speech or gentleshaking (adult victims only),and whether these indicate animprovement or a deteriorationin his condition, then pass thisinformation on to the paramedicswhen the ambulance arrives.

• If a conscious victim becomesunconscious, open the airway(p.13), check breathing (p.14),and dial 911 or call EMS.

Shake an adultvictim gently bythe shoulders tosee if he responds

13RESUSCITATION TECHNIQUES

OPENING THE AIRWAY (adults and children)

OPENING THE AIRWAY (babies under 1)

1Tilt head back• Gently place one hand on the

victim’s forehead.

• Tilt the head back by pressingdown on the forehead.

2Remove anyobstruction• Look inside the victim’s mouth.

Carefully pick out any obviousobstruction with your fingers.

3Lift chin• Place two fingers of the other hand

under the chin and lift it gently.

• Tilt the head to open the airway.Check breathing (p.14).

3Lift chin• Place one finger of the other hand

under the chin and lift it gently.

• Tilt the head slightly. If you tilt ittoo far, you may block the airwayagain. Check breathing (p.14).

Using twofingers, gentlylift up the chin

1Tilt head back• Place one hand on the baby’s

forehead, then tilt the headby pressing on the forehead.

2Remove anyobstruction• Pick out any obvious obstruction

in the mouth with your fingertips.

Do not over-extend thebaby’s neck

!Important• If you suspect that there are head

or neck injuries, handle the headcarefully. Tilt the head back slightly.

• Do not sweep your fingers blindlyaround the mouth.

BEFORE YOU START

Make sure that you have:

• Checked for consciousness buthad no response (p.12).

BEFORE YOU START

Make sure that you have:


Important• Always be very gentle with a baby’s head

when tilting it back.

!

14 F IRST AID

2Prepare to turn victim• Bring the arm farther from you

across the victim’s chest, andplace the back of his hand underhis near cheek.

• Pull his far leg into a bent position;keep his foot on the floor.

• Pull his knee toward you.

Use leg aslever toturn body

2Treat victim• If breathing has stopped, begin

rescue breaths (pp.16–17).

• If the victim is breathing butunconscious, place him in therecovery position (see below andopposite), then check for injuries.

1Look formovement• Kneel beside the victim and put

your cheek close to his mouth.Listen and feel for any signs ofbreathing, while looking alonghis chest for signs of movement.

• Do this for up to 10 seconds.

1Position armsand legs• Kneel next to the victim.

• If the victim is wearing eyeglasses,remove them. Also remove anybulky objects from his pockets.

• Position the arm closer toyou so that it lies at a rightangle to his body, with hiselbow bent at a right angle and the palm facing upward.

CHECKING FOR BREATHING (all ages)

RECOVERY POSITION (adults and children)

BEFORE YOU START

Make sure that you have carried outthe following steps:


• Opened the victim’s airway (p.13).

BEFORE YOU START


• Checked for consciousness but hadno response (p.12).


• Checked for breathing and founddefinite signs (see above).

Look downacross the chestto see if it rises

Keep palmfacing up

15RESUSC ITAT ION TECHNIQUES

3Turn victim• Continue to pull the upper leg

so that the victim rolls ontohis side. If necessary, support hisbody with your knees so that hedoes not roll too far forward.

• Leave the victim’s hand supportinghis head, and tilt the head so thatthe airway stays open.

4Support victim• Adjust the victim’s hand so that it

supports his head. Bend the hip andknee of his upper leg at right anglesso that this leg supports his body.

• Check that an ambulance is onthe way.

• Check and record the victim’sbreathing (p.68 for an adult,p.71 for a child), pulse (p.68

for an adult, p.70 for a child),and consciousness (p.12)until help arrives.

Keepleg bent

1Pick up baby• Hold the baby securely in

your arms so that his headis lower than his body.

• Tilt the baby’s head backto keep the airway openand to allow any vomit todrain from his mouth.

• Ensure that you keep the baby’shead, neck, and back alignedand supported at all times.

2Monitor baby • Monitor the baby’s breathing

(p.71), pulse (p.70), and levelof consciousness (p.12)

until help arrives.

Important• If you suspect a spinal injury, do not move

a baby unless the breathing is impeded orhe is in danger.

!BEFORE YOU START



• Opened the baby’s airway (p.13).

• Checked for breathing and founddefinite signs (see p.14).

Important• If you suspect a spinal injury, do not move

the victim unless his breathing is impededor he is in danger. Maintain his open airway.

!

Keep the baby’shead tilteddownward tolet fluid drain

RECOVERY POSITION (babies under 1)

16 F IRST AID

GIVING RESCUE BREATHS (adults and children)

1Breathe intovictim’s mouth• Check that the victim’s airway

is still open.

• Pinch the victim’s nose closed withyour thumb and index finger.

• Take a deep breath, then placeyour open mouth tightly aroundhis so that you form a good seal.

• Blow air into his mouth forabout 2 seconds.

2Watch chest • Lift your mouth away from the

victim’s mouth, keeping yourhands in place to maintain hishead position.

• Glance at the victim’s chest; youshould see his chest fall as the airleaves his lungs. This is called aneffective breath. Repeat the breath.

4Check for signsof circulation• Look for any signs that indicate

circulation – breathing, coughing,and movement of limbs – for upto 10 seconds.

• If there are signs of circulation,continue rescue breathing, giving10 breaths per minute for adultsand 20 for children. Recheck forsigns of circulation every minute.

• If the victim starts breathingagain, place him in the recoveryposition (pp.14–15).

• If there are no signs of circulation,begin CPR (pp.18–20).

Blow steadilyinto thevictim’smouth

3Repeat breathing• If there is no chest movement,

readjust his head and try again.

• Repeat rescue breaths up to fivetimes or until you achieve twoeffective breaths. Then check forsigns of circulation (see step 4). OR

• If his chest fails to move even afterrescue breathing, check for signsof circulation. If you know thatthe victim has choked and hischest still does not move, donot check for circulation butgo straight to CPR (pp.18–20).

BEFORE YOU START




• Checked for breathing but foundno signs (p.14).

Keep checkingto see if his chestrises and falls


GIVING RESCUE BREATHS (babies under 1)

1Breathe intobaby’s mouth• Make sure that the baby’s airway

is still open.

• Take a breath. Seal your lipsaround both the mouth and nose.

• Attempt to give about one breathper second.

2Watch chest• Glance at the baby’s chest; it should

rise and fall. Repeat rescue breaths.

• If the chest does not move, readjustthe airway and try again.

• Try up to five times or until youachieve two effective breaths. Checkfor signs of circulation. OR

• If the chest still does not move,check for signs of circulation.

• If you know the baby has chokedand the chest still does not move,do not check for circulation butgo straight to CPR (p.20).

3Check circulation• Look for any signs that indicate

circulation – breathing, coughing,and movement of limbs – for upto 10 seconds.

• If there are signs of circulation,continue rescue breathing (at arate of one breath per 3 seconds).If there are no signs of circulation,begin CPR (p.20).

pic

Important• If you have a face shield (p.60), use

this when giving rescue breaths toprevent cross-infection.

• If the victim has swallowed a corrosivepoison, use a face shield to protectyourself from the effects of the chemical.

• Before giving the first breath, makesure that the victim’s head is tilted backand the airway is open.

!Place the shield on thevictim’s face,with the filterover her mouth

BEFORE YOU START




• Checked for breathing but foundno signs (p.14).

!Important• When giving rescue breaths to a baby,

be careful not to blow too hard.

18 F IRST AID

1Find compressionpoint• Lay the victim on a firm surface.

• Kneel beside the victim, level withhis chest. Slide your fingers (usingthe hand farther from his head)along the lowest rib to the pointwhere it meets the breastbone.

• Position your middle and indexfingers at this point.

• Place the heel of your other handon the breastbone, just above yourindex finger.This is thearea of thechest whereyou mustapply thecompressions.

2Position hands• Lift away the fingers of your

first hand and lay this hand on topof your other hand.

• Interlock your fingers, so thatthe fingers of your bottom handare not touching the chest.

• Kneel upright with your shouldersdirectly above the victim and yourelbows locked straight.

Place fingerswhere the victim’s lower rib andbreastbone meet

3Compress chest • Press downward, depressing the

breastbone by 11/2–2 inches (4–5 cm)on an average adult, then releasethe pressure but do not removeyour hands from the chest.

• Compress the chest in this way15 times at a rate of about 100compressions per minute (roughlythree every 2 seconds), maintaining

an even rhythm.

GIVING CPR (adults and children over 7)

Raise fingersaway fromthe chest

Keep your handsin position betweencompressions

BEFORE YOU START




• Checked for breathing but found nosigns (p.14).

• Given two effective rescue breathsand checked for signs of circulationbut found none (p.16) OR

• Attempted two rescue breaths andchecked for signs of circulation butfound none (p.16).


5Repeat CPR cycles• Continue giving cycles of 15 chest

compressions and two rescuebreaths until help arrives.

• If the circulation returns or thevictim starts breathing at any time,stop CPR and place him in therecovery position (pp.14–15).

• Stay with the victim and monitorhis breathing (p.68), pulse (p.68),and level of consciousness (p.12)until help arrives.

1Find compressionpoint• Lay the child on a firm surface.

• Find the base ofthe breastbone(see opposite),then positionone hand on thelower half of thechild’s breastbone.

2Give compressions• Kneel upright with your shoulders

directly above the child’s chest andyour elbow locked straight.

• Press downward, so that youare depressing the breastboneby one-third of the depth of thechest, then release the pressurewithout removing your hands.

• Compress the chest five times at arate of about 100 compressions perminute, keeping an even rhythm.

• Give one rescue breath.

3Repeat CPR cycles• Continue giving cycles of five chest

compressions to one rescue breath.

• If the child’s circulation and/or breathing return, placehim or her in the recovery

position (pp.14–15).

• Stay with the childand monitor his orher breathing (p.71),pulse (p.70), and

level of consciousness(p.12) until help arrives.

GIVING CPR (children 1–7)

4Give rescue breaths• Give the victim two rescue

breaths (p.16).

Position onehand readyfor compressions

BEFORE YOU START





• Given two effective rescue breathsand checked for signs of circulationbut found none (p.16) OR


Pinch the noseand tilt the chinbefore placingyour mouth overthe victim’s

20 FIRST AID

Place two fingerson the breastbonejust below nipple line

Seal yourmouth overthe baby’snose andmouth

GIVING CPR (babies under 1)

1Find compressionpoint• Lay the baby on a firm surface.

• Position the tips of two fingers ofone hand on the baby’s breastbone,a finger’s width below the nipples.This is the point where you mustapply the compressions.

2Compress chest• Press downward, so that you

depress the breastbone by one-third of the depth of the chest,then release the pressure withoutmoving your hands.

• Compress the chest five times at arate of about 100 compressions perminute, keeping an even rhythm.

• Give one effective rescue breath.

Look for chestmovements

Listen forbreathing

!Important• When giving rescue breaths to a baby,

be careful not to blow too hard.

3Repeat CPR cycles• Continue giving cycles of five

chest compressions and onerescue breath.

• If the baby’s circulation and/orbreathing return, stop CPRand hold him or her in therecovery position (p.15).

• Stay with the baby and monitorhis or her breathing (p.71), pulse(p.70), and level of consciousness(p.12) until help arrives.

BEFORE YOU START





• Given two effective rescue breathsand checked for signs of circulationbut found none (p.17). OR


21RESUSCITATION TECHNIQUES • UNCONSCIOUSNESS

An interruption in the normal activity of the brainresults in unconsciousness. This potentially life-threatening condition requires immediate medicalhelp. The aims of first-aid treatment are to check thevictim’s level of consciousness, open the airway andcheck breathing, then, if the victim is breathing, toput him or her in a stable position until help arrives.

TREATING UNCONSCIOUSNESS (all ages)

UnconsciousnessSIGNS & SYMPTOMS

• No response to loudnoise or gentle shaking

• Closed eyes

• No movement or sound

1Checkconsciousness• Check the victim for signs

of consciousness (p.12).

• Open the victim’s airway (p.13)and check her breathing (p.14).

• If the victim is not breathing, beginrescue breaths (p.16 for adults andchildren, p.17 for babies).

• If the victim is breathing, place herin the recovery position (pp.14–15for adults and children, p.15 forbabies) and treat any injuries(see step 3).

3Treat injuries• Examine the victim gently for any

serious injuries.

• Control any bleeding (p.31).Check for and support suspectedbroken arms or legs (pp.44–45).

4Monitor victim• Stay with the victim until medical

help arrives.

• Monitor her breathing regularly(p.68 for an adult, p.71 for achild or baby) and pulse (p.68for an adult, p.70 for a childor baby) every 10 minutes.

• Check for any changes in thevictim’s level of consciousness byasking simple questions or shakingher gently every 5–10 minutes.

2Summon help• Dial 911 or call EMS.

• Look for clues to the cause of thecondition, such as needle marks,medical warning bracelets, oridentification cards.

• Ask bystanders for any informationthey may have that you can giveto the emergency services.

Keepleg bent

!Important• Do not move the victim unnecessarily in case

there is spinal injury.

• If you need to leave the victim to get help,place her in the recovery position (pp.14–15for adults and children, p.15 for babies).

• Do not shake a baby or child.

• Be prepared to begin resuscitation (pp.12–20).

• Do not give an unconscious victim anythingto eat or drink.

22 FIRST AID

An obstruction of the airway, usually caused by foodor a foreign object, can result in choking. The aim offirst-aid treatment for choking is to dislodge the objectas quickly as possible. This involves encouraging thevictim to cough, then, if necessary, using thrusts. Ifthe obstruction is not removed, the victim will stopbreathing and lose consciousness.

TREATING CHOKING (adults and children over 7)

Choking (adults and children)

SIGNS & SYMPTOMS

• Coughing, difficulty inbreathing and talking

• Signs of distress, includingholding the throat

• Red face and neck, laterturning gray-blue

1Encouragecoughing• Ask the victim to cough. This may

dislodge whatever is blocking thevictim’s windpipe.

• Check a child’s mouth to see ifanything has been dislodged.

2Give abdominalthrusts• If the victim is becoming weak, or

stops breathing or coughing, carryout abdominal thrusts. Standbehind the victim and put botharms around the upper part of theabdomen. Make sure he isbending forward.

• Clench your fist andplace it (thumb inward)between the navel andthe bottom of thebreastbone. Graspyour fist with yourother hand. Pullsharply inwardand upward up tofive times.!Important

• If the victim becomes unconscious,open the airway, check breathing, andbe prepared to begin resuscitation(pp.12–20).

• If the victim is pregnant or obese, oryou cannot reach around the victim’sabdomen, give chest thrusts instead ofabdominal thrusts. Position your fist inthe middle of the victim’s chest, grabyour fist with the other hand, and pullsharply inward up to five times.

Encourage victimto cough

3Check mouth• Check his mouth. If the obstruction

is still not cleared, repeat steps 2and 3 up to three times, checkinghis mouth after each step.

• If the obstruction still has notcleared, Dial 911 or call EMS.Continue until help arrives or thevictim becomes unconscious.

23CHOKING (ADULTS AND CHILDREN)

3Give abdominalthrusts• If the child shows signs of

becoming weak, or stopsbreathing or coughing, carryout abdominal thrusts.

• Put your arms around the child’supper abdomen. Make surethat he is bending well forward.

• Place your fist between the naveland the bottom of the breastbone,and grasp it with your other hand.Pull sharplyinward andupward upto five times.Stop if theobstructionclears.

1Encouragecoughing• If the child is still able to breathe,

encourage him to cough. This mayhelp dislodge the obstruction, andshould always be tried before other

method, such as abdominalthrusts, are used.

TREATING CHOKING (children 1–7)

2Check mouth• Check the child’s mouth carefully

to see if anything has beendislodged. Encourage him to spit it out, then make sure that theobstruction has been cleared. 4Check mouth

• Check the victim’s mouth again tosee if anything has been dislodged,and remove the object carefully.

• If the obstruction is still notcleared, repeat steps 3 and 4 up tothree times.

• If the obstruction still has notcleared, dial 911 or call EMS.

• Continue giving abdominal thrustsuntil help arrives or the childbecomes unconscious.

Encouragechild tocough

!Important• Do not sweep your finger around the

child’s mouth since you might pushan object farther down the throat.

• If the child becomes unconscious,open the airway, check breathing,and be prepared to beginresuscitation (pp.12–20).

Give fiveabdominalthrusts

24 FIRST AID

Important• Do not blindly sweep your finger

around the mouth.

• If the baby becomes unconscious, openthe airway, check breathing, and prepareto begin resuscitation (pp.12–20).

• Do not attempt to use abdominalthrusts on a baby.

2Give chest thrusts• If the baby is still

choking, lay her faceupwards and placetwo fingers on herbreastbone, justbelow nipple level.

• Push sharplyinto her chestwith your fingersup to five times.

• Check her mouthagain and removeanything that youcan see.

Babies under 1 can easily choke on small objects.A choking baby may squeak, turn red then blue inthe face, or appear to cry without making a noise.The aim of first-aid treatment is to dislodge theobject as quickly as possible, using chest thrusts.If the obstruction is not removed, the baby willstop breathing and lose consciousness.

TREATING CHOKING

Choking (babies under 1)

1Give back slaps• Position the baby face down

along your arm, with yourhand supporting her head.

• Slap her back sharplyup to five times.

• Turn her overand look in hermouth to see ifanything hasbeen dislodged.

• If it has, pick itout carefully.

!

SIGNS & SYMPTOMS

• High-pitched squeak-likesounds, or no noise at all

• Difficulty in breathing

• Red face and neck,turning gray-blue

3Repeat treatment• If the obstruction still has

not been dislodged, repeat thesequence of back slaps and chestthrusts three more times.

• If the obstruction has not beencleared after all efforts havebeen made, call an ambulance.

• Take the baby with you whenyou go to call the ambulance.

• Repeat the treatment sequencewhile you are waiting for theambulance to arrive.

Give five sharpchest thrusts

Give fiveback slaps

25CHOKING (BABIES UNDER 1) • HEART ATTACK

A heart attack is usually caused by a blockage ofthe blood supply to the heart. The aims of first-aidtreatment for a heart attack are to make the victimcomfortable and to arrange for prompt transport tothe hospital. The chances of surviving a heart attackhave improved significantly in recent years, but itis still vital that the victim be treated by medicalprofessionals as soon as possible.

TREATING A HEART ATTACK

Heart attackSIGNS & SYMPTOMS

• Sharp chest pain oftenextending down left arm

• Nausea and vomiting

• Feeling faint and breathless

• Gray skin and blueish lips

• Pulse that quickens andthen weakens

1Make victimcomfortable• Raise the victim’s shoulders so that

he is half-sitting and support himwith cushions or pillows.

• Bend his knees and support themwith more pillows.

• Reassure him and keep him ascalm as possible.

2Summon help • Dial 911 or call EMS. Tell the

dispatcher that you are withsomeone who is probablyhaving a heart attack.

• Call the victim’s doctor, if you arerequested to do so.

3Help withmedication • If the victim has medication for

angina, help her take it.

4Monitor condition• Keep the victim calm and rested.

• Check and record the victim’sbreathing (p.68), pulse (p.68), andlevel of consciousness (p.12) untilmedical help arrives.

Important• Do not allow the victim to eat or drink.

• If the victim falls unconscious, open hisairway, check breathing, and be preparedto begin resuscitation (pp.12–20).Prop up legs

with cushionsor pillows

Support victim’sback with cushionsor pillows

!

26 FIRST AID

Important• Do not use a preventive inhaler

during an attack.

• If the victim becomes unconscious,open her airway, check breathing,and be prepared to beginresuscitation (pp.12–20).

Call an ambulance if• This is the first attack and the victim

does not have an inhaler.

• The asthma does not improve aftertwo doses of reliever inhaler.

• The victim is exhausted and is findingbreathing increasingly difficult.

2Providemedication• Give the victim her reliever inhaler,

and ask her to take a dose.

• If the victim is a child, he orshe may need to have a spacerattached to the inhaler (p.167).

• The effect of the inhaler shouldbe obvious within minutes if it is a mild asthma attack.

During an asthma attack, muscle contractions causethe airways of the lungs to narrow, leading toswelling and inflammation of the airways’ linings.This results in difficulty breathing, which can belife-threatening. The aims of first-aid treatment for anasthma attack are to help the victim to breathe andto seek medical help if symptoms do not improve.

TREATING AN ASTHMA ATTACK

Asthma attack

1Calm victim• Sit the victim down in a

comfortable position. Leaningforwards isusually best.

• Reassure andcalm her.

• Tell herto breatheslowly anddeeply.

SIGNS & SYMPTOMS

• Breathing becomes difficult

• Frequent dry, wheezy cough

• Difficulty talking

• Gray-blue tinge to skin

!

3Repeat the dose• If the inhaler has eased the

symptoms, ask the victim torepeat the dose.

• Encourage her to continuebreathing slowly and deeply.

• Tell her to inform herdoctor if the attackwas unusually severe.

If inhaler iseffective, askvictim to repeatthe dose

27ASTHMA ATTACK • SHOCK

Any severe injury or illness, such as severe bleedingor burns, that dramatically reduces the flow of bloodaround the body can cause shock. If shock is nottreated rapidly, vital organs may fail. The aims offirst-aid treatment are to treat any obvious causeof shock, to improve the blood supply to the vitalorgans, and then to get the victim to the hospital.

TREATING SHOCK

ShockSIGNS & SYMPTOMS

• Fast, then weakening, pulse

• Gray-blue tinge to lipsand skin

• Sweating and cold,clammy skin

• Dizziness and weakness

1Treat causeof shock• If the cause of shock is obvious,

for example severe bleeding(see p.31), treat it accordingly.

2Make victimcomfortable• If the victim is breathing normally,

lay him on the floor or anotherfirm surface, on top of a blanketif the surface is cold.

• If his legs are not injured, raiseand support them so that they areabove the level of his heart.

• Keep the victim still.

• Loosen any restrictive clothingaround his neck, chest, and waist.

• If he is cold, cover him with ablanket or clothing.


Raise legs

Insulate from cold

!Important• Stay with the victim at all times, except if

you need to dial 911 or call EMS.

• Keep the victim still.

• Do not let the victim eat, drink, or smoke.

• If the victim becomes unconscious, open hisairway, check breathing, and be prepared tobegin resuscitation (pp.12–20).

4Monitor victim• Monitor the victim’s breathing

(p.68 for an adult, p.71 for achild or baby), pulse (p.68 for anadult, p.70 for a child or baby),and level of consciousness (p.12)every 10 minutes until help arrives.

Keep his head lowerthan his chest

28 FIRST AID

2Make victimcomfortable• If the victim is conscious,

help him into a sitting positionto ease difficulty breathing.

People who have an extreme sensitivity to a specificsubstance can suffer a rare and severe type ofallergic reaction known as anaphylactic shock. The reaction spreads through the body, causing asudden drop in blood pressure and narrowing ofthe airways, and can be fatal. The aims of first-aidtreatment are to help the victim inject epinephrine(Epipen) and to summon help.

TREATING ANAPHYLACTIC SHOCK

Anaphylactic shock

1 Summon help• Dial 911 or call EMS, or ask

someone else to do so.

• Tell the dispatcher if you knowwhat has caused the reaction.

SIGNS & SYMPTOMS

• Itchy red skin rash

• Swollen face, lips, andtongue

• Anxiety

• Difficulty breathing,wheezing

!

4Monitor victim• Monitor victim’s breathing (p.68

for an adult, p.71 for a child orbaby), pulse (p.68 for an adult,p.70 for a child or baby), and levelof consciousness (p.12) every10 minutes until help arrives.

3Look for Epipen• If the victim has an Epipen, get it

for him so that he can administer it.

• Epinephrine is usuallyadministered

into the outerthigh, throughany clothing.

Sitting up shouldaid victim’sbreathing

Important• Stay with the victim at all times, except if you

have to leave him to dial 911 or call EMS.

• If the victim becomes unconscious, openhis airway, check his breathing, and beprepared to begin resuscitation(pp.12–20).

Place Epipenagainst thigh anddepress needle

29ANAPHYLACTIC SHOCK • HEAD INJURY

Although a head injury sometimes leaves no visiblewound, there may be obvious bruising or bleeding atthe site. The victim may have a headache. The aims of first-aid treatment are to control bleeding, dress thewound, and seek medical help. Even apparently minorhead injuries should always be seen by a doctor.

TREATING A HEAD INJURY

Head injurySIGNS & SYMPTOMS

• Bleeding or bruising at thesite of the wound

• Depression in the skull

• Dizziness or nausea

• Headache and memory loss

1Treat visiblewounds• If there is a scalp wound, replace

any skin flaps.

• Press a clean pad firmly over thewound to control the blood flow.

• Maintain the pressure for at least10 minutes until the blood flowhas been controlled.

• Secure a bandage around thevictim’s head to hold thepad in position.

2Assess victim• Check that the victim is fully

conscious by asking simple,direct questions in a clear voice.

• If she answers your questions,lay her down in a comfortableposition, then arrange fortransport to the hospital.

• If the victim does not respond, asksomeone to dial 911 or call EMS.

• If you need to leave an unconsciousvictim, place her in the recoveryposition first (pp.14–15) unlessyou suspect a spinal injury.


(p.68 for an adult, p.71 for a childor baby), pulse (p.68 for an adult,

p.70 for a child orbaby), and level ofconsciousness (p.12)every 10 minutesuntil help arrives.

!Important• Use disposable gloves and/or wash your

hands well when dealing with body fluids.

• If the victim becomes unconscious, open herairway, check her breathing, and be preparedto begin resuscitation (pp.12–20).

Dial 911 or call EMS if• The victim is unconscious, appears confused,

or her condition is deteriorating.

• There is a depression or soft patch in herskull, or blood or watery fluid is leaking fromher ears or nose; these indicate a skull fracture.

Lie victim down incase of shock

Use a pillowto supporther head andshoulders

30 FIRST AID

2

An interruption of the blood supply to the brain,caused by a blood clot or a ruptured artery in thebrain, is known as a stroke. The effect of a strokedepends on which part, and how much, of thebrain is affected. Although a major stroke can befatal, a minor stroke is not life-threatening, anda full recovery is possible. Whether the victim isconscious or unconscious, it is important that he orshe is taken to hospital as soon as possible in orderto minimize any brain damage caused by the stroke.

TREATING A STROKE

Stroke

1 Lay victim down• Make the victim comfortable by

laying her down and supportingher head and shoulders slightly withcushions or rolled-up blankets.

• Tilt her face to one side to allowany fluid to drain out of hermouth, and wipe her face with awashcloth. Alternatively, placesomething absorbent on hershoulder to soak up the fluid.

• Loosen restrictive clothing aroundher neck and chest.

SIGNS & SYMPTOMS

• Acute headache

• Confusion, which could bemistaken for drunkenness

• Weakness or paralysis,possibly on just one sideof the body, manifested inslurred speech, droopingmouth, and a loss of limb,bladder, or bowel control

• Possible unconsciousness

Use washclothto absorb anyfluid

Summon help• Ask someone to dial 911 or call

EMS immediately.

Important• Do not allow the victim to have anything to

eat or drink.

• If the victim is or falls unconscious, open herairway, check breathing, and be prepared tobegin resuscitation (pp.12–20).

!

3Monitor victim• Check and record the victim’s

breathing (p.68), pulse (p.68),and level of consciousness (p.12)every 10 minutes until help arrives.

31STROKE • SEVERE BLEEDING

A heavy loss of blood is often distressing and can be life-threatening. The aimsof first-aid treatment are to stop the bleeding, dress the wound as quickly aspossible, and respond to any condition, such as shock or unconsciousness, thatmay result from heavy loss of blood or from the wound itself.

TREATING SEVERE BLEEDING

Severe bleeding

1

2Lay victim down• If the bleeding does not stop, lay

the victim on a firm surface,keeping the injured part raised.

• Loosen any restrictive clothing.

3Secure dressing • Bandage the wound dressing

firmly but not too tightly (p.61,checking circulation).

• If blood seeps through the dressing,cover it with another one. Ifbleeding continues, remove bothdressings and apply a fresh one.

4Summon help• Ask someone to dial 911, or

do so yourself.

5Monitor victim• Watch for signs of shock (p.27).

• Monitor the victim’s breathing(p.68 for an adult, p.71 for a childor baby), pulse (p.68 for an adult,p.70 for a child or baby), and levelof consciousness (p.12) every10 minutes until help arrives.

Control blood flow• If necessary, remove or cut away

any clothing to expose the wound.

• Cover the injury with a sterilewound dressing, a clean pad ifyou have one, or with your hand.

• Press the wound firmly for 10minutes, or longer if necessary,until the bleeding stops. Usedisposable gloves if available.

• If possible, raise injured part abovethe victim’s heart level. If part maybe fractured, handle it with care.

Important• Use disposable gloves and/or wash your


• Do not apply a tourniquet.

• If there is an object in a wound, place paddingon either side of the object so that thedressing will rest on the pads, not the object.

• If the victim becomes unconscious, open herairway, check her breathing, and be preparedto begin resuscitation (pp.12–20).

!

Keep firm, even pressureon the wound untilbleeding stops

Keep part raisedabove heart level

32 FIRST AID

A deep wound to the chest can cause direct orindirect damage to the lungs, which may lead to acollapsed lung, and damage to the heart. The aimsof first-aid treatment for a penetrating chest woundare to stop the bleeding, to help prevent the victimfrom going into shock, and to get the victim to thehospital for treatment as quickly as possible.

TREATING PENETRATING CHEST WOUNDS

Penetrating chest wounds

1Control blood flow• Expose the wound and press the

palm of your hand against it, orget the victim to do it himself.

• Support the victim in a semi-upright or half-sitting position.

SIGNS & SYMPTOMS

• Difficult, painful breathing

• Acute distress

• Presence of frothy blood at mouth

• Possible signs of shock

3Make victimcomfortable• Encourage the victim to lean

toward the side of the wound.

• Try to make him as comfortableas possible, using additionalcushions or pillows to supporthim as necessary.

• Loosen any restrictive clothingaround his waist.

Cover pad withplastic wrap andsecure with tape

2Dress wound• Cover the wound with a sterile

dressing or clean pad.

• Cover the dressing with a pieceof aluminum foil, plastic wrap, ora plastic bag to prevent air fromentering the chest cavity.

• Secure the dressing with a bandageor strips of adhesive or micro-porous tape. Apply the tape tothree sides of the dressing only.



• If the victim is or falls unconscious, open hisairway, check his breathing, and be preparedto begin resuscitation (pp.12–20).

• If you need to put him in the recovery position(pp.14–15), lay him on his injured side.

!

4 Summon help• Dial 911 or call EMS. Tell the

dispatcher where the injury is anddescribe the extent of the bleeding.

• Watch carefully for any signs ofshock developing (p.27).

33PENETRATING CHEST WOUNDS • CUTS AND SCRAPES

Small wounds, such as cuts and scrapes, rarely bleedfor long and require little in the way of first-aidtreatment. What is important, however, is to clean thewound and apply a sterile wound dressing as quicklyas possible in order to minimize the risk of infection.Check, too, that the victim’s tetanus immunization isup to date, and arrange a booster dose if necessary.

TREATING CUTS AND SCRAPES

Cuts and scrapesSIGNS & SYMPTOMS

• Oozing blood

• Localized pain

• Scraped area containingdirt and dust particles

1Clean wound• Sit the victim down and reassure

her. Even a minor fall can leave avictim feeling shaky.

• Rinse dirt from the cut or scrapeunder cold running water.

• Gently clean the entire wound areawith sterile gauze swabs. Use anew swab for each stroke and workfrom the wound outward.

• Lift any loose material, such asglass, gravel, or metal with thecorner of a gauze swab.

• Carefully pat the area dry witha clean gauze swab.

2Dress wound• For smaller cuts and scrapes,

cover the injured area with anadhesive bandage.

• For larger injuries, place a sterilewound dressing over the injuryand bandage it in place (p.61).

• Rest the injured limb, preferablyin a raised position.

Protect scrapewith an adhesivebandage

Sit victimdown

Washscrape



• Do not touch the cut or scrape with yourfingers to avoid infecting the wound.

• Avoid using cotton or any other dry fluffymaterial to clean a cut or scrape – suchmaterial is likely to stick to the wound.

!

34 FIRST AID

SIGNS & SYMPTOMS

• Fine piece of wood stickingout of skin

• Dark line under skin surface

• Blood oozing from puncturein skin

Important• Do not attempt to use a needle to lever

out the splinter.

• Use disposable gloves and/or wash yourhands well when dealing with body fluids.

2Pull out splinter• Grip the splinter with the

tweezers, then pull it out in astraight line in the oppositedirection to which it entered.

• Try not to break the splinter.

It is very common to find small splinters of woodembedded in the skin of hands, knees, and feet,especially those of children. It is usually possible toremove splinters by hand or using tweezers, havingmade sure that the wound has first been cleaned andthe tweezers sterilized. If splinters remain embeddedor lie over a joint, seek medical help.

TREATING SPLINTERS

Splinters

1 Sterilize tweezers• Using soap and warm water, clean

the affected area thoroughly.

• Sterilize a pair of tweezers byheating them in a flame.

!

3Clean wound• Squeeze the area around the

wound to make it bleed. This helpsto flush out any remaining dirt.

• Clean the affected area and coverit with an adhesive bandage.

• Check that the victim’s tetanusimmunization is up to date.

4Dress embeddedsplinter• If the splinter breaks, or will not

come out, place pads on either side,and a bandage over it, taking carenot to press down on the splinter.

• Seek medical help.

Sterilizetweezersin a flame

Squeeze area to encourage a little bleeding

Grasp splinterand pull itstraight out

35SPLINTERS • EYE WOUND

Any wound to the eye is potentially serious. Blowsto the eye can cause bruising or cuts, and sharpfragments of materials, such as glass, can becomeembedded in the eye’s surface. Even a superficialscrape can result in scarring and vision deterioration.The aims of first-aid treatment for an eye wound areto prevent any further damage, to dress the wound,and to get the victim to the hospital.

TREATING AN EYE WOUND

Eye woundSIGNS & SYMPTOMS

• Sharp pain in injured eye

• Visible wound or bloodshot eye

• Partial or total loss of vision

• Blood or clear fluid leakingfrom injured eye

1 2Dress wound• Hold a sterile wound dressing or

clean pad over the injured eye, orask the victim to do it, and askhim to keep his uninjured eye still.

• Keep his head steady.

Tell victim to keepboth eyes still

3Summon help• Ask someone to dial 911 or call

EMS. If you call yourself, firstplace some cushions under thevictim’s head for support.

• Alternatively, if you can keep thevictim still and laying down, takehim to the hospital yourself.

Support hishead

Keepinjured eyecovered

Keep victim still• Lay the victim on a firm surface,

placing a blanket underneath him if it is cold.

• Kneel down and support his headon your knees,

holding it as stillas possible.

• Tell him tokeep bothhis eyes shutand still.

Important• Do not touch the affected eye or

allow the victim to touch it.

!

36 FIRST AID

!Important• If anything is stuck to the eye, penetrating the

eyeball, or resting on the colored part of theeye, treat as for an eye wound (p.35).

• Do not touch the affected eye or allow thevictim to touch it.

2Flush out object• If you can see something floating

on the white of the eye or trappedunder the lower lid, try to flush itout with clean water.

• Tilt the head so that the injuredeye is lower than the other one.

• Pour water carefully intothe corner of the injured eye,allowing the liquid to drain away.

• Alternatively, tell the victim toimmerse her face in a sinkful ofwater and try blinking.

Eyelashes, bits of dust, and dislodged contact lensesare common eye irritants. They usually float on thewhite of the eye, and can be easily removed. Anythingthat rests on the coloured part of the eye or is stuckon or embedded in the eye’s surface, however, willdemand hospital attention. Your aims are to preventinjury to the eye and seek hospital care, if necessary.

TREATING A FOREIGN OBJECT IN THE EYE

Foreign object in the eye

1Examine eye• Sit the victim down so that she

is facing the light.

• Using two fingers, gently separatethe upper and lower eyelids so thatyou can examine the eye.

SIGNS & SYMPTOMS

• Eye pain or discomfort

• Blurred vision

• Red or watering eye

3Lift off object• If flushing does not work, use

the corner of a clean, dampenedhandkerchief or tissue to lift theforeign object off the eye.

• Do not use any pressure.

5Seek medical help• If all your efforts to remove the

foreign object are unsuccessful,take the victim to the hospital.

4 Inspectupper eyelid• Look under the upper eyelid to see

if a foreign object has lodged there.To remove it, ask the victim tograsp the upper lashes and pullthe eyelid over the lower one.

• If this fails to help, bathe the eye inwater and ask the victim to blink.

37FOREIGN OBJECT IN THE EYE • CHEMICALS IN THE EYE

When splashes of chemicals get into the eyes, theycan cause serious damage, resulting in scarring and even blindness. The primary aim of first-aidtreatment is to effectively irrigate the eye, or flush itwith water, in order to disperse hazardous substances.The next step is to dress the eye, and then seekhospital care for the victim.

TREATING CHEMICALS IN THE EYE

Chemicals in the eyeSIGNS & SYMPTOMS

• Eye redness and swelling

• Watering of the eye

• Sharp pain in the eye

• Signs of chemicals nearby

1Rinse eye• If the victim cannot open his

eye, use your finger and thumb togently separate the two eyelids.

• Hold the affected eye undergently running cold water forat least 10 minutes.

• Be careful that water being rinsedfrom the injured eye does notdrain into the other eye or splasheither you or the victim.

• If it is easier, use a jug or glassto pour water onto the eye.

2Seek medical help• Ask the victim to hold a sterile

pad, or one made from clean, nonfluffy material, such as ahandkerchief, over the injured eye.

• If possible, identify the chemical.

• Take or send himto the hospital.

Covereye withclean pad

Wash eyewith coldwater for10 minutes

Wearprotectivegloves

!Important• Do not touch the affected eye or allow the

victim to touch it.

• If chemical spray is the irritant, face thevictim into the wind. Do not attempt to flushit out using water.

• Wear gloves to protect yourself.

38 FIRST AID

Important• Do not wash the mouth out, as this

may disturb a clot.

• If the wound is large, or if it is stillbleeding after 30 minutes of pressure,consult a dentist or doctor.

1Replant tooth• If an adult tooth is knocked out,

replant it in its socket as soon aspossible and tell the victim to seea dentist right away.

• If you cannot replant the tooth,keep it in milk or water until thevictim reaches a dentist or doctor.

• If a baby tooth is knocked out, donot attempt to replant it.

Damage to a tooth and cuts to the mouth lining, lips, or tongue are commoncauses of bleeding from the mouth. The aim of first-aid treatment is to controlsevere bleeding; large amounts of blood, if swallowed, can cause vomiting,while inhalation of blood can cause choking.

TREATING BLEEDING FROM THE MOUTH

Bleeding from the mouth

1Control bleeding• Ask the victim to sit

with his head tiltedforward. Thishelps the blood todrain away. Givehim a bowl tospit into.

• Press a gauze padon the wound for upto 10 minutes to stopthe bleeding.

2!

2Monitor wound• If the wound continues to bleed,

take a fresh gauze pad and reapplypressure for 10 more minutes.

• Encourage the victim to spit outblood rather than swallow it.

TREATING A KNOCKED-OUT TOOTH

Control bleeding• If the knocked-out tooth cannot

be found, place a thick gauze padacross the socket, making surethat the pad stands higher than theteeth on either side of the gap.

• Tell the victim to bite on the pad.

Reposition missing adulttooth in its socket

Press a padon the wound

Clean gentlywith cotton

39BLEEDING FROM THE MOUTH • NOSEBLEED

Important• Do not allow the victim to lie down or tilt

her head back; the blood could trickle down her throat and cause vomiting.

• If the blood is thin and watery, this indicates afractured skull. Seek medical help immediately.

2Assess situation• After 10 minutes, release the

pressure on the victim’s nose.

• If the bleeding continues whenthe pressure is released, pinchher nose for 10 more minutes.

• If, after 30 minutes, the nose isstill bleeding, take her to thehospital. Keep her leaning forward.

A nosebleed is most often caused by the rupturing of blood vessels inside thenostrils. This can happen following a blow to the nose, sneezing or blowingthe nose. Nosebleeds occur more frequently during bouts of cold or flu whenthe blood vessels are more fragile. The aims of first-aid treatment for anosebleed are to control the bleeding and to comfort the victim. A child,in particular, may find the sight and smell of the blood upsetting.

TREATING A NOSEBLEED

Nosebleed

1Control bleeding• Seat the victim with her head

leaning forward over a bowl.

• Ask her to pinch her nose justbelow the bridge and to breathethrough her mouth. If the victim is a child, pinch it for her.

• Tell her to avoid coughing, spitting,sniffing, swallowing, or speaking,since any of these actions coulddisturb a blood clot.

!

3Clean victim• When the bleeding has stopped,

clean the blood away withlukewarm water, ensuring that thevictim is still leaning forward.

• Tell the victim to rest for a while.

• Advise her not to blow her noseas it could disturb the blood clots.

Pinch hernostrilstogether for 10 minutes

Tell her to spitinto a bowl

40 F IRST AID

Childbirth is rarely an emergency, since the very nature of labor means that itusually lasts for hours, therefore there is generally plenty of time to summonmedical help. In the event that you do have to care for a woman who is about togive birth, however, your aims should be to call for medical help, to support thewoman and keep her calm, and to care for the baby when he or she is born.

TREATING EMERGENCY CHILDBIRTH

Emergency childbirth

3Prepare equipment• Assemble as many of the following

items as possible: disposablegloves; face mask or piece ofcotton material; sanitary napkins;plastic bags; warm water; plasticsheeting or newspapers; cleantowels; pillows; blankets.

• Wash your hands and nailsthoroughly, even if you will bewearing disposable gloves.

• Put on a face mask or improviseone out of clean cotton material.

• Cover whatever surface the motheris laying on with plastic sheeting ornewspapers. Add a layer of towelson top for comfort and absorbency.

1 Summon help• Dial 911 or call EMS, telling

the dispatcher the name of thehospital where the woman is dueto give birth, her expected deliverydate, and any other relevantinformation.

2Make womancomfortable• Try to make the woman reasonably

comfortable as she copes with thecontractions. She may want to sitpropped up, with her knees drawnup, or she may prefer to kneel,with her upper body leaning onsome pillows or folded blankets. It is best to take the lead from her as to what is comfortable.

• Encourage her to breathe slowlyduring and after the contractions.Regular breathing should calm herand help with the pain; it alsogives her something toconcentrate on.

Support herwith pillows

Leaning forwardsfrom a kneelingposition can helpto reduce back ache

41EMERGENCY CHILDB IRTH

4Monitor birth• If the woman feels the urge to

push, encourage her to bear downwith each contraction.

• Tell her when the widest part ofthe baby’s head is visible. At thispoint she needs to stop pushingand change her breathingtechnique to panting.

• Check for a layer of membraneover the baby’s face. If there isone, tear it away.

• Check that the umbilical cord isnot wrapped around the baby’sneck. If it is, then very gently pull it over the baby’s head toprevent strangulation.

• Once the baby’s head andshoulders are visible, the nextcontraction should expel the rest of the baby’s body.

5Check baby• Lift up the baby very carefully and

lay her on her mother’s stomach.

• Newborn babies will appear blueinitially. Look for signs ofcirculation (p.17). If the babyremains blue and shows no signs oflife, begin resuscitation (pp.12–20).

6Wrap baby• Wrap the baby in a clean blanket or

towel, still with the umbilical cordattached, and give her tothe mother to hold.

• If the mother cannothold the baby, placethe baby on herside on a firmbut softsurface.

7Deliver afterbirth • Mild contractions will continue

after the baby is born until theplacenta is delivered.

• Put the placenta into a plastic bagso that a doctor or midwife cancheck that it is complete.

• Clean the mother with warmwater and towels and give hersanitary napkins to absorb anyfurther bleeding.

• Some bleeding is normal, but if thebleeding seems excessive, massagethe mother’s stomach just belowthe navel to help control the flow.

• Advise the mother to breastfeed,if possible, because it encouragesthe uterus to contract.

!Important• Do not give the mother anything to eat.

• Do not pull the baby’s head and shoulders out.

• Do not cut the umbilical cord.

• Do not dispose of the afterbirth.

• Do not smack the baby.

42 FIRST AID

A convulsion, or major seizure, is the result of anelectrical disturbance in the brain and consists ofmuscular spasms and loss of body control. Seizuresthat are recurrent usually indicate the brain disorderepilepsy. The aims of first-aid treatment for majorseizures are to protect the victim from injuringherself and to summon medical help if necessary.

TREATING MAJOR SEIZURES

Major seizuresSIGNS & SYMPTOMS

• Rigid body with archedback and clenched jaw

• Eyes rolled upwards

• Convulsive shaking

• Seizure followed by sleep

1Protect victim • If you see the victim falling at

the beginning of the seizure, try to prevent injury as she falls.

• Do not move her while she ishaving the seizure.

• Loosen the clothing around herneck and try to protect

her head with somethingsoft, such as a piece of

folded clothing.

2Monitor victim• After the seizure, the victim may

fall into a deep sleep. Check herbreathing (p.14), open her airway,and be prepared to resuscitate her.

• If the victim is breathing, place herin the recovery position (pp.14–15).

3Summon help• If you know the victim has

epilepsy, and she only has oneseizure at this time, stay with heruntil she has recovered.

• If you are not certain that thevictim is susceptible to epilepticseizures, dial 911 or call EMS.

• If the victim remains unconsciousfor more than 10 minutes orconvulses for more than 5 minutes,or if she has repeated seizures, dial911 or call EMS.

• Monitor the victim’s breathing(p.68 for an adult, p.71 for a

child or baby), pulse (p.68 foran adult, p.70 for a child

or baby), and level ofconsciousness

(p.12)until helparrives.

!Important• Move sharp objects away from the victim.

• Do not use force to restrain the victim.

• Do not put anything in the victim’s mouth.

Protect thevictim’s head

Do not try to restrain thevictim during the seizure

43MAJOR SEIZURES • FEBRILE SEIZURES

Important• Do not use force in an attempt to restrain

the child.

• Do not put anything in the child’s mouth.

2Cool child• Remove clothing or bedcovers

to cool the child down.

• Working from the head down,sponge the child’s body all overwith tepid water.

• Do not dry the child; instead,allow the moisture to evaporatefrom her skin.

• Do not let her get too cold.

Seizures that occur in young children as a resultof a very high temperature are known as febrileseizures. Children under the age of 5 are most likelyto suffer from a seizure, which is alarming to watchbut is rarely dangerous to the child. The aims of first-aid treatment are to lower the child’s temperature,protect her from injury, and summon medical help.

Febrile seizures

1Protect child• Place pillows, rolled-up blankets,

towels, or clothing around thechild to help protect her from injury.

• Do not move the victim while sheis having a seizure.

SIGNS & SYMPTOMS

• Arched back, clenched fists,stiff legs and arms

• Eyes rolled upwards

• Head and body jerking

• High fever

!

3Get help• Dial 911 or call EMS.

4Monitor victim• Monitor the child’s temperature

at regular intervals (p.70).

• Give the recommended doseof acetaminophen liquid whenthe seizures have stopped.

• Stop cooling her down as soonas her temperature reaches anormal 98.6°F (37°C).

Use rolled-uptowels or pillowsto protect the child

Sponge the child withtepid water until hertemperature falls

TREATING FEBRILE SEIZURES

44 FIRST AID

The fracture of an arm bone is not as serious as thatof a leg bone (p.45) because the victim is usuallyable to walk and get to the hospital relatively easily.The aims of first-aid treatment for a broken arm areto control any bleeding, to support the injured armwith a sling, and to transport the victim to thehospital, keeping the arm as still as possible.

TREATING A BROKEN ARM

Broken armSIGNS & SYMPTOMS

• Limb held at awkward angle

• Limb cannot be moved

• Severe pain

• Swelling and bruising

• Possible wound abovefracture site

1Support arm• Sit the victim down.

• If there is a wound, treat anybleeding (p.31).

• Ask the victimto support theinjured arm acrosshis chest so that itfeels comfortable.Tell him to holdthe injuredhand a littlehigher thanthe elbow.

2Put arm in sling • Put some padding between the

arm and the chest for comfort,then support the injured armwith a sling (p.63).

• To keep the arm still, tie anotherfolded triangular bandage aroundthe chest and over the sling.

3Seek medical help• Take or send the victim to the

hospital to have the injury assessed.

• Make sure that the arm is keptstill during the trip to the hospital.

!Important• Do not give the victim anything to eat,

drink, or smoke.

• If the elbow is injured, do notattempt to bend the arm. Lay thevictim down, surround the limbwith padding, and dial 911 or call EMS.

• An injured arm may not be fractured,but if you are in doubt, treat it as afracture until it can be x-rayed.

Keep the armraised slightly

Use extrabandage tokeep thearm still

Tie slingaroundneck

45BROKEN ARM • BROKEN LEG

The fracture of a leg bone is a serious injury thatrequires immediate hospital treatment. It is importantthat the victim does not put any weight on theinjured limb. Thigh bone fractures may involve severeinternal bleeding, which can cause shock. The aimsof first-aid treatment are to control any bleeding, tosupport the limb, and to dial 911 or call EMS.

TREATING A BROKEN LEG

Broken leg

1Support leg• Help the victim to lie down.

• If there is a wound, treatany bleeding (p.31).

• Put plenty of soft padding, suchas rolled-up blankets or towels,on each side of the fractured leg.

• Dial 911 orcall EMS.

SIGNS & SYMPTOMS

• Limb held at awkward angle

• Limb cannot be moved

• Severe pain

• Swelling and bruising

• Possible wound or internalbleeding if thigh is injured

2Immobilize leg• If you can stay with the victim,

and there is no need to move her,leave the padding in place and,if necessary, support the legwith your hands.

• If you need to move the victim outof danger, immobilize the injuredleg by bandaging it to the otherone. Tie folded triangularbandages around the joints aboveand below the fracture site.

3Monitor victim• Watch for signs of shock (p.27).

• Check her breathing (p.68 for anadult, p.71 for a baby or child)and pulse (p.68 for an adult,p.70 for a baby or child) whilewaiting for help to arrive.

Hold the injuredleg steady

Use a rolled-up towelto support the leg

!Important• Do not give the victim anything to eat,

drink, or smoke.

• Do not move the victim unlessshe is in danger.

• An injured leg may not be fractured,but if you are in doubt, treat it as afracture until it can be x-rayed.

46 FIRST AID

Damage to the spinal cord can cause permanent lossof movement below the injured area, therefore allspinal injuries are potentially serious. The aims offirst-aid treatment of a suspected spinal injury are todial 911 or call EMS, and to keep the victim immobileuntil medical help arrives, because even the slightestmovement could damage the spinal cord.

TREATING SPINAL INJURIES

Spinal injuriesSIGNS & SYMPTOMS

• Pain in neck or back

• Burning sensation ortingling in a limb

• Loss of feeling in a limb

• Inability to move legs


2Immobilize victim• Leave the victim in the position in

which you found her.

• Reassure her and support herhead to prevent any movement.

• Ask someone to place rolled-upclothes or towels on either sideof the victim’s head and bodyto help keep her still.

• Stay with her until help arrives.

3Monitor victim • Monitor her breathing (p.68 for

an adult, p.71 for a child or baby),pulse (p.68 for an adult, p.70 fora child or baby), and level ofconsciousness (p.12) every 10minutes while waiting for help.

!Important• Do not move the victim unless she is

in danger or needs to be resuscitated.

• If she loses consciousness, open her airwayby tilting her head only slightly, and monitorher breathing.

• If breathing becomes difficult for her, haveseveral other people help to move the victiminto the recovery position. Put your handsover her ears to keep her head aligned and,working as a team, roll her over very gently,making sure that you keep the neck andback aligned at all times.

Hold victim’shead still

47SPINAL INJURIES • SPRAINS AND STRAINS

2Cool injury• Prepare a cold compress: either

soak a washcloth or towel in coldwater and wring it out lightly,wrap a towel around a packet offrozen peas, or fill a plastic bagwith small ice cubes. Apply thecompress to the affected area toreduce swelling, bruising, and pain.

• Do not apply ice directly to theskin, because this can burn it.

Sprains occur when ligaments and other tissues thatsurround and support a joint are torn or stretched.A strain refers to muscles or tendons that aredamaged or overstretched. Both injuries may leadto pain, swelling, deformity, and discoloration.Treatment follows the “RICE” procedure: rest,ice (or cold pack), compression, and elevation.

TREATING SPRAINS AND STRAINS

Sprains and strains

1 Support injury• Steady and support the injured part.

• For extra support, place the injuredlimb on your knee or in your lap.

SIGNS & SYMPTOMS

• Pain and swelling in theaffected area

• Deformity and discoloration

3Apply compression• Place a thick layer of padding, such

as cotton wool, around the injury.

• Secure the padding in place witha roller bandage (p.62) to apply agentle, even pressure to theinjured area. Make surethat the bandage is nottoo tight (p.61).

4Elevate injury• Raise and support the limb to help

reduce bruising and swelling.

• Advise the victim to rest the limband to see a doctor.

Use coldcompress toreduce swelling

Important• When you apply compression, make sure that

you do not obstruct the blood supply to thetissues surrounding the injured area (p.61).

!

Securepadding with bandage

48 FIRST AID

A burn that affects all the layers of the skin or coversa large area of the body is a severe burn. The aim offirst-aid treatment is to cool down the affected arearapidly to minimize damage and loss of body fluids,and therefore reduce the risk of developing shock.Any burn larger than the palm of the victim’s hand,whatever the depth, needs hospital treatment.

TREATING SEVERE BURNS

Severe burnsSIGNS & SYMPTOMS

• Skin that is red, brownand charred, or white

• Blisters

• Unconsciousness

• Clear fluid dripping from skin

• Signs of shock (p.27)

1Put out fire• If the victim’s clothing is on fire,

force her to the ground and usea wool or cotton blanket, rug, orcoat to smother the flames (p.182).

• If possible, have someone dial 911or call EMS for medical help and,if necessary, the fire department.

2Cool burn• Immerse the burn in cool water,

douse it with water, or cover itwith cold, wet towels for at least10 minutes.

• If there is no water, use cold milkor a canned drink to cool the burn.

5

3Expose injury• Gently remove any clothing, shoes,

belts, or jewelry near the burn, butleave anything that is stuck to it.

• Cover the burn with a sterile wounddressing or clean nonfluffy material.

4Make victimcomfortable• Lay the victim down, keeping the

burn away from the ground and, ifpossible, above heart level.

• Dial 911 or call EMS if help is notalready on the way.

Monitor victim• Monitor the victim’s breathing

(p.68 for an adult, p.71 for a childor baby), pulse (p.68 for an adult,p.70 for a child or baby), and levelof consciousness (p.12) every 10minutes while waiting for help.

• Watch for signs of shock (p.27).

Important• Do not apply any ointments to the burn.

• Do not touch the burn or burst any blisters.

• Do not put ice or iced water on the burn.

!

49SEVERE BURNS • SMALL BURNS AND SCALDS

2Expose injury• Gently remove any clothing,

shoes, belts, or jewelry near theburn before the area starts to swell and blister.

• Do not remove anything thatis stuck to the burn becausethis could worsen the injury.

A burn that damages only the outer layer of the skinor affects a relatively small area is a minor burn orscald. Although such burns can be red and painfuland may swell and blister, most heal well within afew days if treated promptly. Your aims are to coolthe burn and to cover it with a sterile wounddressing to minimize the risk of infection.

TREATING MINOR BURNS AND SCALDS

Minor burns and scalds

1Cool burn• Pour cool water over the injured

area for at least 10 minutes.

• If there is no water, use cold milkor a canned drink to cool the burn.

SIGNS & SYMPTOMS

• Red and painful skin

• Blisters dripping clear fluid

4Monitor wound• Check the wound daily for any

signs of infection, such as pain,swelling, redness, or pus.

• If you suspect that it has becomeinfected, advise the victim to see adoctor at once.

3Dress burn• Cover the burn with a sterile wound

dressing or clean nonfluffy material.

• Wrap a bandage loosely over thedressing to secure it (p.61).

Wear glovesto reducerisk ofinfection

Cool the burnwith water

Important• Do not apply anything other than cool

liquid to the burn.

• Do not touch the burn or burst any blisters.

• Do not put ice or iced water on the burn.

!

50 FIRST AID

Ultraviolet rays in sunlight can damage cells in theouter layer of human skin, causing soreness, redness,and blistering. Skin can burn after just 30 minutesof exposure to the sun and sunburn is most likely tooccur in the middle of the day, though symptoms maynot develop immediately. The aims of treatment areto move the victim out of the sun, to cool the affectedarea, and to apply soothing lotions or creams.

TREATING SUNBURN

SunburnSIGNS & SYMPTOMS

• Very red, hot skin

• Soreness

• Swelling

• Blistering

• Possible signs of heatstroke(p.52)

1Move victim inside• If the victim is outside, move him

into the shade or indoors.

3Give fluid• See that the

victim sipsplenty of coldwater whileyou cool his skin.

4Apply lotion• Gently smooth calamine lotion

or after-sun cream onto the burnedareas. Reapply as necessary.

2Cool burn• Get the victim into a cold bath, or

apply damp towels or cold water tothe burn for at least 10 minutes.

!Important• If the skin is badly blistered, advise the

victim to see a doctor.

• If the victim has severe sunburn andheatstroke (p.52), call 911.

Cool theburnedareas

Put creamon burn

Ensure thathe takessmall sipsof fluid

51SUNBURN • HEAT EXHAUSTION

Caused by excessive sweating, heat exhaustionoccurs when vital salt and water are lost throughthe skin. People who are unused to hot and humidconditions, and those suffering from any illness thatcauses diarrhea and vomiting, are often the mostsusceptible. The aims of first-aid treatment are tocool the victim and to replace lost salts and water.Heat exhaustion can develop into heatstroke.

TREATING HEAT EXHAUSTION

Heat exhaustion

1Make victimcomfortable• Move the victim to a cool place.

• Lay him down and support hislegs in a raised position to improvethe blood flow to vital organs.

SIGNS & SYMPTOMS

• Feeling dizzy or confused

• Headache and nausea

• Sweating, with pallid,clammy skin

• Arm, leg, or abdominalcramps

• Fast but weak pulse


(p.68 for an adult, p.71 for a childor baby), pulse (p.68 for an adult,p.70 for a child or baby), and levelof consciousness (p.12) every10 minutes until help arrives.

Summon help• If the victim becomes weaker

or confused, place him in therecovery position (p.14 for adultsand children, p.15 for babies).

• Dial 911 or call EMS.

3

2Replace lost fluids• Give him cool, salty drinks.

Ideally, offer isotonic drinks ora weak salt and sugar solution(1 teaspoon of salt and 4 teaspoonsof sugar to 1 liter of water).

• Support his head while he isdrinking, if necessary.

• If he recovers, askhim to see a doctor. Important

• If the victim loses consciousness, open hisairway, check his breathing, and be preparedto begin resuscitation (pp.12–20).

!

Raisehis legs

Give hima coolisotonicdrink

52 FIRST AID

If the human body is exposed to unusually hightemperatures for a prolonged period, it can becomedangerously overheated. The onset of heatstroke canbe sudden, and the victim may lose consciousnesswithin minutes. The aims of first-aid treatment areto move the victim to a cool place, to reduce histemperature, and to get him to a hospital quickly.

TREATING HEATSTROKE

HeatstrokeSIGNS & SYMPTOMS

• Headache and dizziness

• Hot, flushed skin

• Poor level of response

• Rapid pulse

• Raised body temperature(over 104°F/40°C)

1Make victimcomfortable• Move the victim to

a cool place.

• Remove as muchof his clothingas possible.


3Cool victim• Drape a cold, wet sheet over the

victim. Spray or sprinkle it withwater to keep it wet. Alternatively,sponge him with cold or tepidwater, or fan him with cold air.

• Keep cooling the victim until histemperature drops to 100°F (38°C)under the tongue or 99°F (37.4°C)beneath the armpit (p.68 for anadult, p.70 for a child or baby).

4Monitor victim• Once the victim’s temperature has

fallen to 98.6°F (37°C) under thetongue or 97.7°F (36.5°C) beneaththe armpit, replace the wet sheet(if used) with a dry one.

• Monitor the victim’s conditionuntil medical help arrives.

• If his temperature rises again, coolhim down following the sameprocedure as before.

Sponge his faceand body withtepid water

Lay him downin a cool place

Remove hisclothes

Important• If the victim loses consciousness, open his

airway, check his breathing, and be preparedto begin resuscitation (pp.12–20).

!

53HEATSTROKE• FAINTING

Important• If the victim does not regain consciousness,

open her airway, check her breathing, and beprepared to begin resuscitation (pp.12–20).

• Dial 911 or call EMS.

2Make victimcomfortable• Loosen any restrictive clothing.

• Ensure that the victim gets plentyof fresh air. If you are indoors,open a window or fan her face.

• Keep bystanders away.

• Reassure the victim as sherecovers from the faint.

Pain, fright, fatigue, hunger, emotion, or simplystanding still for a long period of time have all beenknown to interrupt the flow of oxygen to the brain,which can cause a temporary loss of consciousness,or a faint. Your aims are to improve bloodflow tothe victim’s brain, to make her comfortable, andto treat any injuries that may have occurred whenthe victim fell. Recovery is usually rapid.

TREATING FAINTING

Fainting

1Raise legs• If the victim has fainted, gently

raise her legs above the level ofher heart to improve blood flow.

• If she feels faint but hasnot fainted, ask her tolay down, and to raiseher legs.

• Support her legs withyour body or with a pileof cushions, pillows,or folded blankets.

SIGNS & SYMPTOMS

• Feeling dizzy, weak, andsometimes nauseous

• Sweating

• Very pale skin

• Low pulse rate

• Brief loss of consciousness

!

4Help victim up• When the victim feels better, help

her to sit up very slowly.

• If the victim begins to feel faintagain, help her to lay down.

• Raise and support her legs again,until she feels fully recovered.

• Help her to sit up again, movingvery slowly and making sure thatshe no longer feels faint.

• If in doubt about the victim,call her doctor. See chart p.82Feeling faint/passing out.

3Treat any injuries• Look for any injuries that the

victim may have sustained whenshe fell after fainting.

• Treat these injuries appropriately.

Support legsabove levelof heart

54 FIRST AID

The onset of hypothermia is a reaction to the coldand happens when body temperature falls below 95°F(35°C). Hypothermia may develop gradually if thevictim is in a poorly heated house, or rapidly if thevictim is in freezing weather or immersed in coldwater. Your aims are to warm the victim graduallyand to seek medical help if needed.

TREATING HYPOTHERMIA

HypothermiaSIGNS & SYMPTOMS

• Shivering

• Cold, pallid skin

• Weak pulse

• Confusion and apathy

• Extreme fatigue

1Rewarm victim• Get the victim into a shelter.

• Replace any wet clothes withwarm, dry clothes and thenwrap her in a survival blanket.

• If the victim is indoors, is youngand healthy, and is not lethargic

or confused, help her intoa warm, but not hot, bath

and allow her to soak.

2Warm victimin bed• Put the victim to bed and cover

her well with blankets.

• If she is still very cold, help herput on a hat and gloves.

• Give her a warm drink to sip.

3Summon help• If the victim is elderly or a baby,

or if her condition worries you,call a doctor.

Cover herhead witha hat

Help her tosip a warmdrink

After a bath,wrap her inwarm towels

!Important• Do not give the victim alcohol to drink.

• Do not give the victim a hot-waterbottle or place her beside a fire or anyother source of heat.

• If the victim loses consciousness, openher airway, check her breathing, and beprepared to begin resuscitation(pp.12–20).

55HYPOTHERMIA • FROSTBITE

Apply dressing• Cover the affected part with a

light dressing, wrapping thedressing between frostbittenfingers and toes, and cover thepart with a loose gauze bandage.

• Support the part in a raised positionto reduce the chance of swelling.

Frostbite occurs when the body reacts to freezingconditions, particularly those accompanied by a highwindchill factor, by shutting down blood vessels. Asa result, extremities, such as fingers and toes, mayfreeze and if left untreated, could eventually becomegangrenous. Hypothermia (p.54) may also occur.The aims of first-aid treatment are to rewarm thefrostbitten area gradually and to seek medical help.

TREATING FROSTBITE

Frostbite

1Warm frozen part• Get the victim to tuck her frozen

hands into her armpits, or place the frostbitten part in your lap,between your hands to warm it.

• Move the victim out of the cold;help her if her feet are affected.

• Thaw the frostbitten part in a basinof warm water, then pat it dry.

SIGNS & SYMPTOMS

• Sensation of pinsand needles

• Pale skin becomingnumb and hard

• Skin is white, mottledblue, or black

3Relieve pain• As the area thaws, the skin will

become hot, red, and painful.

• Give the victim the recommendeddose of acetaminophen to helpease the pain.

• Take the victim to the hospital orarrange for transportation.

Use your bodyheat to thawfrostbitten toes

Cover with lightdressing and bandage

2

Important• Do not place a source of direct heat

against the frostbitten part.

• Do not warm the frostbitten part if it may refreeze.

• Do not rub the frostbitten part.

!

56 FIRST AID

Important• Do not try to induce vomiting.

• Some poisons can cause anaphylactic shock.Look for warning signs (p.28).

• If the victim loses consciousness, open herairway, check her breathing, and be preparedto begin resuscitation (pp.12–20).

• If you need to give rescue breaths to a victimwho has swallowed a corrosive poison,

protect yourself by using aface shield (see below).

Poisoning can occur as a result of swallowing toxicchemicals or poisonous plants, or by overdosingon recreational or medicinal drugs. Seek immediatemedical assistance and provide the emergencyservices with as much information as possible aboutthe poisoning, including the type of substance thatwas swallowed, the amount, and when.

TREATING SWALLOWED POISONS

Swallowed poisons


• Tell the dispatcherwhat you thinkthe victimhas swallowed.

1Get information• If the victim is conscious, ask her

what poison she has swallowed.

• Look around her forsigns of bottlesor containers.

SIGNS & SYMPTOMS

• Pain in the abdomen or chest

• Nausea, vomiting, anddiarrhea

• Breathing difficulties

• Dizziness

!


(p.68 for an adult, p.71 for a childor baby), pulse (p.68 for an adult,p.70 for a child or baby), and levelof consciousness (p.12) every 10minutes until help arrives.

• Watch for signs of deterioration.

• If alcohol poisoning is a possibility,cover the victim with a blanket.

Ask victim fordetails ofpoisoning

Place the shield onthe victim’s face,with the filter overher mouth

57SWALLOWED POISONS • SNAKE AND SPIDER BITES

A bite from a venomous snake or spider can causesevere pain and burning at the site of the wound, in addition to swelling and discoloration. Mostvictims of such bites recover rapidly if they receiveprompt hospital treatment and are given theappropriate antivenin. The aims of first-aidtreatment are to seek medical assistance quicklyand to try to identify the snake or spider.

TREATING SNAKE AND SPIDER BITES

Snake and spider bitesSIGNS & SYMPTOMS

• Severe pain and burning

• Pair of puncture marks(snake bite)

• Nausea and vomiting

• Sweating

• Breathing difficulties

• Irregular heartbeat

1Keep victim still• Lay the victim down, keeping the

heart above the level of the bite.

• Keep the victim calm and still.

2Clean wound• Wash the wound carefully.

• Pat it dry with clean swabs orother nonfluffy material, butdo not rub it.


• If possible, give the dispatcher adescription of thesnake or spiderthat has bittenthe victim.

4

5Monitor condition• Monitor the victim’s breathing

(p.68 for an adult, p.71 for a childor baby), pulse (p.68 for an adult,p.70 for a child or baby), and levelof consciousness (p.12) every10 minutes until help arrives.

4 Immobilizeinjured part• Place a light compression bandage

on the affected part to minimizeblood flow. Start bandagingjust above the bite and continueup the limb.

• If a leg is affected,tie both legstogetherwith foldedtriangularbandages.

Bind legs togetherto immobilizeinjured leg

Important• Do not catch a venomous spider

or snake to try to identify it.

• Do not apply a tourniquet.

• Do not cut the wound open orattempt to suck out the venom.

!

58 FIRST AID

Any animal bite carries a high risk of transmittinginfection and should be seen by a doctor. Antibioticsor tetanus immunization may be required. Your aimsare to stop the bleeding and clean the wound. Treatinga tick bite involves removing the whole tick.

TREATING ANIMAL BITES

Animal and tick bitesSIGNS & SYMPTOMS

• Puncture marks (animal)

• Pea-sized body attachedto skin (tick)

1Make victim safe• Remove the victim from any

danger, if possible.

3Treat small wound• If the wound is superficial, wash it

with soap and water and pat it dry.Cover with a dressing (p.61).

• Advise the victim to ask his or herdoctor if immunization is needed.

2Treat severewound• If the wound is serious, treat as

for severe bleeding (p.31).

• Take or send the victim to thehospital for urgent treatment.

2Dress wound• Wash your hands thoroughly.

• Clean the wound with antiseptic.

• Cover with an adhesive dressing.

TREATING TICK BITES

1Remove tick• Using a pair of fine-pointed

tweezers, grasp the tick on eitherside of its body(including headand mouthparts).

• Lever out thetick with arocking motion.

Monitor victim• Look out for a rash at the site of

the bite and/or flulike symptomsdays after the bite. In either case,send or take the victim to a doctorin case he or she has developedan infection. Tell the doctorthat the victim was bitten by a tick.

3

Important• Do not apply a hot match, alcohol, or

any other substance to the tick in anattempt to remove it.

• Ensure that you remove both the headand the body of the tick.

!

Important• Do not try to capture the animal.

• Severe infections can be transmitted byanimal bites. Seek medical advice in all cases.

!

59ANIMAL AND TICK BITES • INSECT AND SCORPION STINGS

2Treat wound• Wash the injured area with soap

and water, and pat dry.

• Cover the wound area with anadhesive dressing.

• Apply a cold compress on top ofthe adhesive dressing to reducepain and swelling.

• Advise the victim to seek medicalhelp if symptoms persist.

Bee, wasp, and hornet stings are painful but are notusually life-threatening. There may be a sharp painfollowed by temporary swelling, soreness, and itching.Your aims are to watch out for signs of anaphylacticshock, to remove the stinger, to dress the wound, andto reduce swelling. Scorpion stings can be life-threatening and need urgent medical attention.

TREATING STINGS IN THE MOUTH

TREATING STINGS IN THE SKIN

Insect and scorpion stings

1Reduce swelling• In order to reduce swelling, give

the victim a glass of cold water tosip or ice to suck.

1Remove sting• If there is a stinger in the wound,

gently scrape it off with yourfingernail or a credit card.

• Do not grasp the venom sac withyour fingers or tweezers becausepressure on the sac may injectmore venom into the victim.

SIGNS & SYMPTOMS

• Stinger stuck in skin

• Swollen red area

• Localized pain

Soothe stingwith water


Scrape in theopposite directionto entry

Important• Dial 911 if the victim has been stung by a

scorpion or shows signs of anaphylacticshock (p.28).

!

60 FIRST AID

Having the correct supplies can make a big difference in an emergency, so youshould always keep a selection of essential first-aid materials at home and inyour car. Store the items in a first-aid box or in a similar type of airtightcontainer in a dry place. The box should be easily accessible in an emergencybut kept away from other medicines and out of reach of children. Ideally,the box should be small and light enough for you to carry easily. Check andreplenish the first-aid kit regularly so that the contents are kept up to date.

First-aid equipment

Applicator

Bandage

HOME FIRST-AID KIT

TWEEZERS for removing

splinters

WOUND DRESSINGsterile dressings that

combine bandage anddressing in one

CREPE ROLLER BANDAGESfor applying pressure to a

wound or to support astrain or sprain

GAUZE ROLLER BANDAGES

for holding dressings inplace on any part of the body

TRIANGULAR BANDAGESfor use as a sling to

support and immobilizean injured limb

ADHESIVE BANDAGES

for covering smallcuts and scrapes

COLD PACK for reducing

swelling in sprainsand strains

DISPOSABLE GLOVES for protection from cross-infection when touching

body fluids

ANTISEPTIC CREAM used on cuts and scrapesto help prevent infection

MICROPOROUS TAPEbreathable, low-tack

tape for holdingdressings in place

ANTISEPTIC WIPES for cleaning wounds

SCISSORS for cutting dressings

and bandages

SAFETY PINS for securing bandages

and slings

GAUZE DRESSINGS light dressings for use

directly on wounds

CALAMINE LOTION for treating sore and

sunburned skin

TUBULAR BANDAGEused with a specialapplicator to secure

dressings on fingers or toes

FACE SHIELD for protection from cross-

infection when givingrescue breaths

61FIRST-AID EQUIPMENT

2Bandage in place• Secure the pad in place by winding

the short end of the bandage oncearound the dressing and limb.

• Keep hold of the short end andwind the bandage roll aroundthe dressing and limb. Continuewinding the bandage until thepad is completely covered.

APPLYING A WOUND DRESSING

1Apply dressing pad• Wash your hands thoroughly and

wear disposable gloves, if available.

• Choose a dressing with a pad thatwill cover an area 1 in (2.5 cm)beyond the edges of the wound.

• Unroll the bandage until the padis visible, leaving a short “free”end on one side of the pad anda roll of bandage on the other.

• Place the dressing pad directlyon the wound.

1Apply pressure• Immediately after bandaging a limb,

check the circulation in the fingersor toes beyond the bandage.

• Press on a nail or on the skinuntil the area turns pale, thenrelease the pressure. The colorshould return immediately.

3Secure bandage• Tie the ends of the bandage

together over the pad.

• Check the circulation (see below)and, if necessary, loosen thebandage and reapply.

• If blood seeps through, applyanother dressing over the top. If itseeps through the second dressing,remove both and start again.

3Monitor casualty• Every 10 minutes, check fingers

or toes for signs of poor circulationsuch as pale, cold skin, or numbness.Loosen the bandage and reapplyif necessary.

CHECKING CIRCULATION

2Loosen bandage• If the skin color does not return

immediately, the bandage is tootight and should be loosened.

• Undo a few turns of the bandage.Wait for the color to return to theskin, and reapply the bandage moreloosely. Check circulation again.

Hold theshort end

Make turnswith the mainbandage

62 FIRST AID

APPLYING A HAND OR FOOT BANDAGE

1 Start at wrist• Place the end of the bandage on the

underside of the wrist at the baseof the thumb (or ankle for a footbandage); secure the end by makinga straight turn around the wrist.

• Bring the bandage diagonally acrossthe back of the victim’s hand inthe direction of the little finger.

• Take the bandage under and acrossthe fingers so that the upper edgetouches the index finger about halfway up its length.

2Repeat layers• Take the bandage diagonally

across the back of the hand, thenaround the wrist and back overthe hand towards the little finger.

• Continue, covering two-thirds of theprevious layer with each new turn.

• When the hand is covered, maketwo straight turns around the wrist(or ankle) and secure the bandage.

• Check the circulation in the fingersand toes beyond the bandage (seep.61) and loosen it if necessary.

Bring bandagediagonallyacross hand

Leavefingertips andthumb free

1Apply first layer• Cut a length of tubular gauze

bandage two-and-a-half times thelength of the injured finger or toe.

• Push the gauze on to the applicator,and gently place the applicator overthe finger.

• Hold the gauze in place at the baseof the finger and pull the applicatoroff, leaving a layer of gauze behind.

• Hold the applicator just beyondthe fingertip and twistit twice.

2Apply second layer• Push the applicator back over the

injured finger, until the finger iscovered with the rest of the gauze.

• Remove the applicator.

Secure bandage• Secure the end of the gauze to the

finger with a piece of adhesive tape,leaving a gap in one place.

• Make sure the bandage is not tootight. If the victim complains ofpale cold skin, numbness, or aninability to move the finger or toe,remove the bandage and hold thedressing in place by hand.

3

APPLYING A TUBULAR BANDAGE

63FIRST-AID EQUIPMENT

2Form sling• Bring the lower half of the bandage

up over the forearm to meet theother end of the bandage at theshoulder on the injured side.

• Position theforearm sothat the handis slightlyhigher thanthe elbow.

TYING AN ARM SLING

1 Support arm• Support the injured arm under

the forearm or ask the victim tosupport it with his other arm.

• Pass one end of the bandage underthe victim’s elbow on the injuredlimb and pull the bandage acrossto the opposite shoulder, so thatthe longest edge is parallel with his uninjured side.

3Secure sling• Tie a knot at the hollow over the

victim’s collarbone on the injuredside of the body.

• Tuck both endsof the bandageunder the knotto act aspadding.

4Secure at elbow• Fold the point of the bandage

forwards at the elbow and tuckany loose bandage underneath it.

• Secure the point of the bandageto the front of the bandage witha safety pin, or twist the cornerand tuck it into the sling.

• Check the circulation in the fingersafter securing the sling, and againevery 10 minutes (see p.61). Ifnecessary, remove the sling andstraighten the arm.

Supportforearm

Leavefingersexposed

Longestedge ofbandage

Fold pointforwards

Tie knot overcollarbone

Use safetypin tosecure

When a family member is ill, turn to the symptoms charts in thissection to find out what is wrong. From facial pain to abdominalpain, wheezing to swollen ankles, these charts provide possible

reasons for the symptoms and indicate how you can help.

How to use this section .66Assessing symptoms(adults) ............................68Assessing symptoms(children) .........................70Not feeling well ............72Fever (adults) ..................74Fever (children) ...............76Excessive sweating ........78Lumps and swellings .....80Feeling faint/ passing out ....................82 Headache .......................84 Vertigo ...........................86Numbness and/or tingling......................88Facial pain......................90Difficulty speaking ........91Forgetfulness orconfusion .......................92General skin problems...94Rash with fever .............96Eye pain or irritation .....98Disturbed/impaired vision ............................100Earache ........................102Sore throat ..................103Hoarseness or lossof voice ........................104

Coughing (adults) .........106Coughing (children) ......108Shortness of breath(adults) ..........................110Breathing problems(children) .......................112Wheezing.....................114Difficulty swallowing...115Vomiting (adults)..........116Vomiting (children) .......118Abdominal pain (adults) ..........................120Abdominal pain (women) ........................122Abdominal pain (children) .......................124Abdominal swelling ....126Anal and rectal problems ......................127Diarrhea (adults)...........128Diarrhea (children)........130Constipation ................132Chest pain....................134Palpitations..................136Poor bladder control...137Painful urination .........138Back pain .....................140Neck pain or stiffness...142Arm or hand pain .......144

Leg pain .......................145Joint pain.....................146Swollen ankles.............148Erectile dysfunction ....150Testes and scrotumproblems ......................151Penis problems ............152Breast problems ..........154Menstrual period pain156Heavy menstrualperiods .........................157Abnormal vaginalbleeding.......................158Vaginal discharge........160Genital irritation (women) ........................161Home medicine chest...162Caring for a sick person ...................164

2

FAMILYILLNESS

66

HOW TO USE THE CHARTS

FAMILY ILLNESS

How to use this sectionThis section contains a selection of charts describing symptoms that may causeconcern to family members. At the beginning of the section, there is advice onhow to assess symptoms of illness, such as how to measure body temperature,take a pulse, and check breathing rates. At the end of the section, there areguidelines for looking after a sick person at home, with suggestions for whichmedicines to keep in the home and how to administer them.

Introductory textThis text describescommon causes of therelevant symptom.

84

HeadacheFever and tension in head and neck muscles arecommon causes of headache. Too much alcohol,caffeine, or nicotine may also cause headache. Mostheadaches do not last for more than a few hours. Ifyour headache lasts for more than 24 hours, is notimproved by over-the-counter analgesics, or recursseveral times in a week, consult your doctor.

!Danger signsDial 911 or call EMS if aheadache is accompaniedby any of the followingsymptoms:

•Drowsiness or confusion.

•Weakness of a limb.

•Blurred vision.

•Dislike of bright light.

•Temporary unconsciousness.

FAMILY ILLNESS

Have you hityour head

within the past24 hours?

Head injury

No head injury

Danger signspresent

Vomited afterhead injury

No danger signsor vomiting

ACTION

!DIAL 911 OR CALL EMSThere may be damage

to the tissues thatsurround the brain.

Do you havea fever – a

temperature of100.4°F (38°C)

or above?

Are danger signs present

(see box aboveright) or haveyou vomited?

Fever

No fever

Have youexperienced

nausea and/orvomiting withthe headache?

Yes

No

ACTION

GO TO ANOTHER CHARTFever (adults), p.74, orFever (children), p.76

ACTION

TRY SELF-HELP MEASURESA mild headache iscommon following aminor head injury.

•Take an analgesic(not aspirin). CALL YOUR DOCTORIMMEDIATELYif your headache lastsfor more than 2 hoursor if you develop othersymptoms.

ACTION

TRY SELF-HELP MEASURESSinusitis is the likelycause of your headache.

•Try inhaling steamfrom a bowl of hotwater (p.165).CONSULT YOUR DOCTORif you feel no betterwithin 2 days.

ACTION

CALL YOUR DOCTOR NOWYou have probably amigraine, particularlyif any visual problemsoccurred before theheadache. However,the slight chance of amore serious disorder,such as a stroke, needsto be ruled out if thisis your first migraine.

•Take an analgesicand sips of water.

•Rest in a darkened,quiet room until thepain subsides.If you have had anyprevious attacks, tryto identify and avoidpotential triggers, suchas chocolate.

The pain is feltchiefly in the

areas above andbelow the eyes

Neither

You have recentlyhad a runny or

stuffy nose

Does either ofthe following

apply?

START

Blurred vision

Unchanged

Disturbed inother ways

How is yourvision?

Self-help adviceThis text describes whatyou can do to treat thesymptom at home andwhen you shouldconsult your doctor.

Starting pointFrom the starting point,question and arrowpathways guide youaround the chart.

Question boxEach question isfollowed by two ormore possible answers.Choose the one that ismost applicable.

Action panelsThe text indicates howurgently you should seea doctor.

Possible causeThis text suggestswhat may havecaused the symptom.

Cross-referencesThe charts feature cross-references to other chartscontaining further information.

67HOW TO USE THIS SECTION

Contact the doctor, dayor night, by telephone.Dial 911 or call EMS if youfail to make contact within1 hour.

It is important that thesymptoms are assessed bya doctor within 24 hoursof their onset.

The condition may requiremedical treatment, but areasonable delay is unlikelyto lead to problems.

!DIAL 911 OR CALL EMS

SEE YOUR DOCTORWITHIN 24 HOURS

CALL YOUR DOCTOR NOW

For minor infections, such as a sore throat or runnynose, use self-help measures, first aid, or over-the-counter remedies to relieve discomfort. Alwaysconsult your doctor if you are unsure whether aremedy is suitable and read the manufacturer’sinstructions before taking medication.

TRY SELF-HELP MEASURES

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR

ACTION PANELS

At the end of every pathway you will find apossible diagnosis, advice on what to do, andwhether or not you need to seek medical help.There are five possible levels of attention, rangingfrom DIAL 911 OR CALL EMS, for the most seriousconditions, to TRY SELF-HELP MEASURES, for minorcomplaints. It is important to note, however,that even apparently minor complaints shouldreceive medical attention when they occur inthe elderly or in people who are undergoingcancer treatment.

SPECIAL BOXES

• Red danger signs and warningboxes alert you to situations inwhich emergency medical helpmay save a life. These boxeshighlight advice that applies inparticular medical circumstances.

• Blue information panels tell youhow to gather the informationyou need to answer the questionsin the chart.

Danger signs

Dial 911 or call EMS forthe emergency services.If there is a delay inobtaining an ambulance,go to the hospital by car.

HEADACHE 85

W

h

ACTION

CALL YOUR DOCTOR NOWAcute glaucoma (apainful, rapid risein fluid pressure in theeye) is a possibility,particularly if the painis around your eye.

Over one orboth temples

Elsewhere

Where is thepain?

ACTION

CALL YOUR DOCTOR NOWYou may have temporalarteritis (inflammationof blood vessels in thehead), particularly ifyou are over 50 andare not feeling well.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour symptoms maybe side effects of themedication.

• Stop taking any over-the-counter medicinesbut continue to takeprescribed medicationunless advised to stopby your doctor.

Have you hadthis type ofheadachebefore?

Yes

No

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR if you cannot identifya possible cause foryour headache fromthis chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR A recurrent headachefor which there is noobvious cause, suchas drinking too muchalcohol, should alwaysbe investigated fullyby your doctor.

Medication

No medication

Are you takingany medication?

Possible cause not identifiedIf your symptoms do not suggest adiagnosis, the chart recommendsthat you see a doctor.

Safe alcohol limits One unit of alcohol equalshalf a pint of beer, a smallglass of wine or sherry, or onemeasure of hard liquor.

•The maximumrecommended limit for menis 3 units a day.

•The maximumrecommended limit for

!!Recurring attacks

of vertigoIf you have been experiencingattacks of vertigo, it is veryimportant to avoid certainactivities that are potentiallyhazardous to you and toother people. You should notclimb ladders or steep flightsof stairs, operate machinery,

Checking a red rash

68 FAMILY ILLNESS

Assessing symptoms (adults)Symptoms take many forms. Some involve a new sensation; others involvea change in a normal body function. Certain symptoms can be assessedvery accurately because they can be measured, for example by taking atemperature or a pulse. Others need careful and regular attention to assesswhether something has changed, such as breast or testes examinations.

MEASURING BODY TEMPERATURE

2Assessresult• A result above

100.4°F (38°C)indicates a fever.

1 Insert thermometer• Place a digital thermometer in the

mouth, with the tip under thetongue, and leave it until you hearit “beep”, indicating that it hasmeasured the temperature.

2Assess result• A rate of around 72 beats per

minute is normal for an adult.

• Note the quality of the pulse:if it is regular or irregular,

strong or weak.

1 Find pulse• Place the pads of two fingers

on the inside of a person’swrist, just below the baseof the thumb.

• Press firmly to feel thethrobbing beat ofthe pulse.

• Count the numberof beats per minute.

1Count breaths• Watch for chest movement or place

your hand on the adult’s chest orback so you can feel the breaths.

• Count the number of breaths heor she takes in one minute.

2Assess result• The normal resting breathing rate

is 12–15 breaths per minute.

• Note the quality of the person’sbreathing: if it is fast or slow, easy or labored.

CHECKING BREATHING RATE

Place the pads of thefingers below thevictim’s thumb

TAKING A PULSE

69ASSESSING SYMPTOMS (ADULTS)

1Examine yourselfin a mirror• The best time to check your breasts

is just after your menstrual period.

• Stand in front of a mirror and look closely for dimpled skin andany changes to your nipple or to the size orshape of yourbreasts.

2Feel each breast • Lie down with one arm behind

your head and firmly press eachbreast in small circular movements.

• Feel around the entire breast,armpit area, and nipple.

• If you discovera lump or anychanges, consultyour doctor.

TESTES: SELF-EXAMINATION

1 Look for changes• The best time to examine your

testes is just after a bath or showerwhen the scrotum is relaxed.

• Check the skin of your scrotumfor changes in appearance.

2Feel for lumps• Feel across the entire surface of

each testis by rolling it slowlybetween fingers and thumb.

• Check for lumps and swellings.

• Consult your doctor immediatelyif you detect any change inappearance or texture.

Feel the breast andup into the armpit

BREASTS: SELF-EXAMINATION

Check whether you area healthy weight by usingthe graph (right). Tracea vertical line from yourheight and a horizontalline from your weight.The point at which thelines cross is your bodymass index (BMI), whichindicates whether or notyou are within a healthyrange. Being a healthyweight decreases therisk of cardiovasculardisease and many otherhealth problems.

144 146 148 150 152 154 156 158 160 162 164 166 168 170 172 174 176 178 180 182 184 186 188 190 192 194 cm

lb kg

57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 75 in

UNDERWEIGHT(BMI < 20)

HEALTHY WEIGHT(BMI 20-25)

OVERWEIGHT(BMI > 25)

HEIGHT/WEIGHT GRAPH FOR MEN AND WOMEN210 95

200 90

19085

18080

17075

16070

150

65140

60130

55120

50110

100 45

90 40

HEIGHT

WEI

GH

T

ASSESSING WEIGHT

IBallal

Line

70 FAMILY ILLNESS

MEASURING BODY TEMPERATURE

Assess result• For a mouth or ear reading,

a result above 100.4°F (38°C)indicates a fever.

• For an armpit reading,a result above 99°F(37.4°C) indicates a fever.

1 Insert thermometer• Place a digital thermometer under

the tongue (for a child over 7)or under the armpitand leave it until youhear it “beep,”indicating that ithas measured thetemperature.

• Insert the tipof an auralthermometerinto the ear. Thereading is takenin 1 second.

2Assess result• Count the number of beats you

can feel in one minute.

• A rate of around 140 beats perminute is normal for a baby,

120 per minute for atoddler, and 100 perminute for an older child.

• Note the quality of thepulse: if it is regular orirregular, strong or weak.

Hold the digitalthermometer securelyin place

Find a pulseon the insideof the arm

TAKING A PULSE

Assessing symptoms(children)When a child is not well, temperature, pulse, and breathing rate are importantsymptoms to assess. To monitor your child’s growth, use the height and weightcharts (opposite) to assess whether he or she is within normal ranges.

1Find pulse• For a baby, place two fingers on

the inner side of the arm, halfwaybetween the elbow andthe armpit.

• For a child, place yourfingers on the insideof the wrist, justbelow the base ofthe thumb.

2

71ASSESSING SYMPTOMS (CHILDREN)

Find your child’s age on the bottom andfollow a vertical line up, then find theheight or weight on the left and follow ahorizontal line across. Mark the pointwhere the lines cross. The shaded band

shows the normal range of growth, andthe 5th, 50th, and 95th percentile linesindicate lower, middle, and upper limitsrespectively. If your child’s measurementsfall outside the band, see your doctor.

140

120

100

80

60

40

20

70

60

50

40

30

20

10

00 1 2 3 4 5 6 7 8 9 10 11 12

BOYS’ WEIGHTlb kg

AGE (years)

95th percentile

50th percentile

5th percentile

140

120

100

80

60

40

20

70

60

50

40

30

20

10

00 1 2 3 4 5 6 7 8 9 10 11 12

GIRLS’ WEIGHTlb kg

95th percentile

50th percentile

5th percentile

ASSESSING HEIGHT AND WEIGHT

70

65

60

55

50

45

40

35

30

25

20

180

170

160

150

140

130

120

110

100

90

80

70

60

50

400 1 2 3 4 5 6 7 8 9 10 11 12

BOYS’ HEIGHTin cm

AGE (years)

95th percentile

50th percentile

5th percentile

70

65

60

55

50

45

40

35

30

25

20

180

170

160

150

140

130

120

110

100

90

80

70

60

50

400 1 2 3 4 5 6 7 8 9 10 11 12

GIRLS’ HEIGHTin cm

AGE (years)

95th percentile

5th percentile

1Count breaths• Place your hand on the

child’s chest or back sothat you are able tofeel the breaths.

• Count the number ofbreaths he or she takesin 1 minute.

2Assess result• Compare the child’s breathing rate

with the maximum rate for his orher age shown in the table below.

• Note the quality of the breathing:if it is fast or slow, easy or labored.

CHECKING BREATHING RATE

AGE BREATHS PER MINUTE

Under 2 months Maximum of 60 breaths2–11 months Maximum of 50 breaths1–5 years Maximum of 40 breathsOver 5 years Maximum of 30 breaths

AGE (years)

50th percentile

Use your hand tofeel how fast thebaby is breathing

72

Not feeling wellThere may be times when don’t feel well but areunable to pinpoint a precise symptom. This feelingis commonly caused by the onset of a minor viralillness, psychological pressures, or simply anunhealthy lifestyle. You should always consultyour doctor if the feeling persists because theremay be a more serious underlying problem.

FAMILY ILLNESS



or above?

Fever

No fever

START

ACTION

GO TO ANOTHER CHART Fever (adults), p.74 orFever (children), p.76

Have you lostmore than

10 lb (4.5 kg)over the past

10 weekswithout

changing youreating habits?

Lost over 10 lb(4.5 kg)

Lost under 10 lb(4.5 kg) or

gained weight

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSThere are a numberof possible causes forrapid weight loss, andit is important to seeyour doctor to ruleout potentially seriousconditions such asdiabetes mellitus.

Do you haveany of thefollowing?

Feelingconstantly on edge

Difficultysleeping

Inability toconcentrateor to makedecisions

None of the above

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour symptoms maybe a side effect of themedication.


Safe alcohol limits One unit of alcohol equalshalf a pint of beer, a smallglass of wine or sherry, orone measure of hard liquor.

•The maximumrecommended limit formen is 3 units a day.

•The maximumrecommended limit forwomen is 2 units a day.

Medication

No medication


NOT FEELING WELL 73

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause fornot feeling well fromthis chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour symptoms maybe due to an anxietydisorder or depression.

•Try physical exerciseor some relaxationtechniques (p.169);they may help toalleviate the symptoms.

Possiblypregnant

Not pregnant

Might you bepregnant?

Are youfeeling more

tired thanusual?

More tired

No change

ACTION

TRY SELF-HELP MEASURESBody changes thatoccur soon afterconception can makeyou feel unwell.Symptoms includefatigue, feeling faint,and nausea/vomiting.

• Eat frequent smallmeals throughout theday rather than a fewlarger meals. If yousuffer from morningsickness, eat a snackbefore getting up.

•Lie down if you arefeeling faint or tired.

• If you are not surewhether you arepregnant, use a homepregnancy test orconsult your doctor.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORfor advice aboutreducing the amountof alcohol you drink.Regularly drinking toomuch alcohol canmake you not feel well.

ACTION

TRY SELF-HELP MEASURESYou may have a milddigestive upset as aresult of infection orhaving eaten somethingthat disagrees with you.Your symptoms are notlikely to be dangerous,but severe diarrhea cancause dehydration,particularly in theelderly or very young.

•Avoid rich or spicyfoods and drink plentyof clear fluids. CONSULT YOUR DOCTORif you do not feel betterwithin 2 days or soonerfor a child.


Loss of appetite

Nausea and/orvomiting

Diarrhea

None of the above

Within the limit

Do you regularlydrink more

than therecommended limit of alcohol

(see box opposite)?

More than the limit

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif your fatigue ispersistent or severe andhas no obvious cause.

Rash

No rash

Do you have a rash?

74

Fever (adults)For children under 12, see p.76Normal temperature varies from one person toanother, but if your temperature is 100.4°F (38°C)or above, you have a fever. Most fevers are due toinfection, but heat exposure or certain drugs canalso raise body temperature. In all cases, followthe advice for bringing down a fever (p.164).

!High temperatureIf you are not feeling well,you should take yourtemperature every 4 hours.

•Call your doctor immediatelyif your temperature rises to102°F (39°C) or above.

•Take steps to lower the feverwithout delay (see Bringingdown a fever, p.164).

START

FAMILY ILLNESS


Drowsiness or confusion

Neck pain on bending the

head forwards

Dislike of bright light

None of the above

ACTION

CALL YOUR DOCTOR NOWYou may have a chestinfection, such aspneumonia.

• Follow the advicefor bringing down afever (p.164).

Cough

No cough

Do you have a cough?

ACTION

GO TO ANOTHER CHARTRash with fever, p.96

Severeheadache

No headache

Mildheadache

Do you have a headache?

ACTION

!DIAL 911 OR CALL EMSYou may have

meningitis (infectioninflaming membranesaround the brain).

You are short of breath

Breathing is normal

Breathing is painful

Are you havingproblems

breathing?

ACTION

GO TO ANOTHER CHARTSore throat, p.103

FEVER (ADULTS) 75

Sputum

No sputum

Have you beencoughing up

sputum?

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identify apossible cause for yourfever from this chart.

ACTION

TRY SELF-HELP MEASURESYou probably have aviral illness, such asa severe cold or flu.


•Try inhaling steamfrom a bowl of hotwater (p.165).CONSULT YOUR DOCTORif your symptomsworsen, if you are nobetter within 2 days,or if any othersymptoms develop.

ACTION

TRY SELF-HELP MEASURESYou may have a viralchest infection, suchas acute bronchitis.


•Drink plenty of fluids.

• If you smoke, stop.CONSULT YOUR DOCTORif your symptomsworsen or if you areno better within 2 days.

Sore throat

No sore throat

Do you have a sore throat?

General achesand pains

Neither

Runny nose

Do you haveeither of thefollowing?

Painful

Neither

Abnormallyfrequent

Do you haveproblems with

urination?

Have you hadseveral boutsof fever overthe past few

weeks?

Recurrent fever

No otherrecent fever

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSA long-term infection,such as infectiveendocarditis (inflamedlining of the heart), oran AIDS-related illnessmay cause recurrentfever. Another possiblecause is an underlyingcancer, such aslymphoma (cancer ofthe lymphatic system).

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have cystitisor a urine infectionthat has spread to oneor both kidneys.

• For both conditions,take an analgesic suchas acetaminophen.

•Drink 500 ml (1 pt)of fluid every hour for4 hours.

•Drinking cranberryjuice may help relievethe burning sensation.

76

Fever (children)For adults and children over 12, see p.74

A fever is a temperature of 100.4°F (38°C) or above.If your child is not feeling well, you should take hisor her temperature because a high fever may needurgent treatment. If a feverish child becomesunresponsive, dial 911 or call EMS. In all cases,follow the advice for bringing down a fever (p.164).

!Danger signs Dial 911 or call EMS if yourchild’s temperature risesabove 102°F (39°C) and heor she has any of thefollowing symptoms:

•Abnormally rapid breathing(see p.71).

•Abnormal drowsiness.

•Severe headache.


•Refusal to drink for more than 6 hours.

FAMILY ILLNESS

Under 6 months

6 monthsor over

How old isyour child?START

Rash

No rash

Does yourchild have

a rash?

ACTION

GO TO ANOTHER CHARTRash with fever, p.96

ACTION

CALL YOUR DOCTOR NOWFever in young babiesis unusual unless itoccurs within 48 hoursof immunization. Fevermay indicate an illnessthat could be serious.

Severeheadache


Neck pain onbending the

head forwards

None of the above

Abnormaldrowsiness,irritability,

or confusion

Does yourchild have any of thefollowing?

ACTION

!DIAL 911 OR CALL EMSYour child may have

meningitis.


Is your childreluctant to

move anarm or leg?

Yes

No

ACTION

CALL YOUR DOCTOR NOWYour child could havean infection in a bone,such as osteomyelitis,or a joint infection.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child may haveacute otitis media(middle-ear infection).

•Give liquid acet-aminophen to relievepain and reduce fever.

FEVER (CHILDREN) 77

ACTION

!DIAL 911 OR CALL EMSYour child could

have a respiratoryinfection, such aspneumonia.

•Give liquid acet-aminophen to relievepain and reduce fever.

ACTION

CALL YOUR DOCTOR NOWThis may be croup, inwhich a viral infectioninflames the airways.

• Sit with your childin a steamy bathroomto ease the breathing. ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child may have aurinary tract infection.

•Give plenty of fluidsto drink.

Your child hasbeen pullingat one ear

Your child hascomplained of

earache


apply?

Neither

Does yourchild have

either of thefollowing?

Cough

Runny nose

Neither

Does yourchild have


Painfulurination

Diarrhea withor withoutvomiting

Neither

Sore throat

No sore throat

Does yourchild have asore throat?

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour child’s fever fromthis chart.

ACTION

TRY SELF-HELP MEASURESYour child probably hasa viral illness, such as asevere cold or flu.


•Try inhaling steamfrom a bowl of hotwater (p.165).CONSULT YOUR DOCTORif your child’s conditionworsens, if he or she isno better within 2 days,or if he or she developsother symptoms.

ACTION

TRY SELF-HELP MEASURESYour child may have athroat infection, suchas tonsillitis.


• Follow the advicefor soothing a sorethroat (p.164).CONSULT YOUR DOCTORif your child is no betterin 24 hours or if othersymptoms develop.

ACTION

CALL YOUR DOCTOR NOWif your child is under1 year. He or she mayhave gastroenteritis.

•Give older childrenplenty of clear fluidsto drink.

Is your child’sbreathing

abnormallynoisy or rapid

(see p.71)?

Abnormallyrapid

Noisy

Neither

78

Excessive sweatingSweating is one of the body’s cooling mechanisms.It is a normal response to heat, exercise, and stressor fear. Some people naturally sweat more thanothers. Wearing natural fibers, such as cotton, and using an antiperspirant often help to reducesweating. You should consult your doctor if yousweat excessively and are unsure of the cause.

FAMILY ILLNESS

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may be sufferingfrom hyperthyroidism(an overactive thyroidgland). However,anxiety disordersare another possiblecause of some ofthese symptoms.

ACTION


Mainly at night

At other times

When doesthe sweating

occur?

Well

Unwell

Do you feelotherwise

well?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORHormonal changesassociated with themenstrual cycle ormenopause may causeexcessive sweating.

Sweating occurswith menstrual

periods

Neither

Menstrualperiods have

becomeirregular


apply?



or above?

Fever

No fever

START

Weight losswith increased

appetite

Bulging eyes

None of the above

Feelingconstantlyon edge


EXCESSIVE SWEATING 79

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have a chronicinfection, such astuberculosis, or a cancer,such as lymphoma(cancer of thelymphatic system).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORfor advice aboutreducing the amountof alcohol you drink.

ACTION



ACTION

TRY SELF-HELP MEASURESBeing overweight canlead to excessivesweating, particularlyafter physical exertion.

•Adopt a sensibleweight-reducing diet.

•Wash away sweatregularly and wearcomfortable looseclothing made fromnatural fibers.CONSULT YOUR DOCTORif your symptoms donot improve.

ACTION

TRY SELF-HELP MEASURESExcessive sweating ofthe hands and feet is acommon problem.

•Wash off sweatregularly and wearsocks made fromnatural fibers. Try togo barefoot wheneverpossible.CONSULT YOUR DOCTORif your symptoms donot improve.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identify a possible cause fromthis chart.

Medication

No medication

Are youcurrently takingany medication?

Do you regularlydrink more

than therecommendedlimit of alcohol

(see box below)?

More than the limit

Within the limit

Overweight

Underweight

Ideal weight

Is your weightwithin ideal

limits?

Is the sweatinglimited to

certain partsof the body?

Mainly hands

Mainly feet

Other partsaffected

Safe alcohol limits One unit of alcohol equalshalf a pint of beer, a smallglass of wine or sherry, orone measure of hard liquor.

•The maximumrecommended limit formen is 3 units a day.

•The maximumrecommended limit forwomen is 2 units a day.

80

Lumps and swellingsEnlarged lymph nodes (glands) are often the causeof lumps and swellings under the skin, particularlyin the neck, under the arms, or in the groin. Theseglands usually become swollen due to an infection.The swelling subsides shortly after the infection clearsup. If the lumps are painful or if they are persistentbut painless, you should consult your doctor.

!Painless lumps orswellingsAny painless lump or swellingthat does not disappear within 2 weeks should beseen by a doctor. Althoughin most cases the cause is notserious, a painless lump maybe a sign of cancer. Earlytreatment can be lifesaving.

FAMILY ILLNESS

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have anabscess or a boil.

•Relieve pain byputting a clean clothsoaked in hot wateron the affected areafor 30 minutes fourtimes a day.

Rash

No rash

Do you havea rash?

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may be sufferingfrom infectiousmononucleosis,especially if you’regenerally notfeeling well.

•Drink plenty ofcool fluids.

•Take acetaminophento reduce your fever.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURS A viral infection isthe most likely cause.Lymphoma (cancer ofthe lymphatic system) oran AIDS-related illnessare also possibilities.

What are thecharacteristicsof the lumpor swelling?

Red and painful

Other

STARTAre the lumpsor swellingsin more than

one area?

One area only

Several areas



or above?

Fever

No fever

LUMPS AND SWELLINGS 81

Testis

Breast

Sides or backof neck

Other

Groin

Where isthe lump orswelling?

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSA number of viralillnesses can causeswollen glands and arash. Lyme disease (aninfection that causesa rash and flulikesymptoms) is anotherpossibility, particularlyif you think you mayhave been bitten by atick recently.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identify apossible cause for yourlumps or swellingsfrom this chart.

ACTION

GO TO ANOTHER CHARTTestes and scrotumproblems, p.151

ACTION

GO TO ANOTHER CHARTBreast problems, p.154

ACTION


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have a hernia.

ACTION

TRY SELF-HELP MEASURESAn injury is likely tocause some swelling asa result of damage tothe tissues. An infectedwound or a rash canalso cause nearbylymph nodes to swell.

•Make sure thewound is clean andprotect it with abandage or dressing. CONSULT YOUR DOCTORif there is any pain,redness, or pus aroundthe wound, or if theswelling persists afterthe wound has healed.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORLymph nodes in thegroin often becomeswollen in responseto an infection.

Sore throat

No sore throat

Do you have asore throat?

What happensto the swelling

if you presson it or if you

lie down?

It disappears

It reducesin size

No change

Do you have arecent injury

near the site ofthe swelling?

Injury

No injury

82

Feeling faint /passing outA sensation of dizziness or lightheadedness maybe followed by passing out (loss of consciousness).The cause is usually lack of food or a reduction inblood flow to the brain. A brief episode of feelingfaint without other symptoms is not a cause foralarm, but you should consult your doctor if suchepisodes recur or if you have passed out.

!UnconsciousnessIf someone remainsunconscious for more than a minute or so, whatever thesuspected cause, you shouldget emergency medical help.

• If you need to leave theperson to call for help,first lay him or her in therecovery position (pp.14–15).

•Do not move the person if you suspect spinal injury.

FAMILY ILLNESS

ACTION

!DIAL 911 OR CALL EMSYou may have had

a stroke.

ACTION

!DIAL 911 OR CALL EMSYou may have some

bleeding within thedigestive tract, perhapsfrom a stomach ulcer(an eroded area of thestomach lining) orfrom an inflammationin the colon.

ACTION

CALL YOUR DOCTOR NOWYou may have hada mini-stroke.

Bloodstainedvomit

Black, tarryfeces

None of the above

Red blood inthe feces

Have younoticed any ofthe following?

ACTION

!DIAL 911 OR CALL EMSif this is your first

attack. You may havehad a seizure, possiblydue to epilepsy. CONSULT YOUR DOCTORif you have hadprevious similar attacks.

Are any of thesymptoms still

present?

Disturbed vision

Confusion

Difficultyspeaking

None of the above

Numbness,weakness, or tingling

Have you hadany of thefollowing?

Symptomspresent

Symptoms nolonger present

Did any of thefollowing occur

when youpassed out?

You twitcheduncontrollably

You bit yourtongue

You urinated

None of the above

START

FEELING FAINT/PASSING OUT 83

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you passed out, or inthe next few days evenif you did not pass out.The most likely causeis a temporary drop inblood pressure due toa change in position.

ACTION

CALL YOUR DOCTOR NOWYou may have lowblood pressure due toan irregular heartbeator worsening of anexisting heart condition.

ACTION

CALL YOUR DOCTOR NOWLow blood sugar (whichmay be due to excessiveinsulin treatment)could be the cause.

•Eat or drinksomething sugary now.

You have hadchest pain oryou have a

heart condition

You have hadpalpitations


apply?

Neither


Shortness of breath

Paler skinthan normal

Inordinatefatigue

None of the above

You havediabetes

Neither

You had noteaten for several

hours beforepassing out


apply?

ACTION

MAKE AN APPOINTMENT TO SEE YOUR DOCTORFainting is common inearly pregnancy. If youare not sure whetheryou are pregnant, do ahome pregnancy test.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may be anemic.This can be confirmedby a blood test.

Possiblypregnant

Not pregnant

Might you bepregnant?

ACTION

CALL YOUR DOCTOR NOWif you passed outand cannot identifya possible cause fromthis chart. SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause forfeeling faint.

ACTION

TRY SELF-HELP MEASURESSudden shock can leadto feeling faint or evenpassing out.

•Rest and ask someoneto stay with you untilyou feel better.

• Follow the first-aidadvice for treatingfainting (p.53)CONSULT YOUR DOCTORif it happens again.

Did you feelfaint or pass out

immediatelyafter either ofthe following?

Emotionalshock

Getting upsuddenly

Neither

84

HeadacheFever and tension in head and neck muscles arecommon causes of headache. Too much alcohol,caffeine, or nicotine may also cause headache. Mostheadaches do not last for more than a few hours. Ifyour headache lasts for more than 24 hours, is notimproved by over-the-counter analgesics, or recursseveral times in a week, consult your doctor.

!Danger signsDial 911 or call EMS if aheadache is accompaniedby any of the followingsymptoms:


•Weakness of a limb.

•Blurred vision.


•Temporary unconsciousness.

FAMILY ILLNESS

Have you hityour head

within the past24 hours?

Head injury

No head injury

Danger signspresent

Vomited afterhead injury

No danger signsor vomiting

ACTION

!DIAL 911 OR CALL EMSThere may be damage

to the tissues thatsurround the brain.



or above?

Are danger signs present

(see box aboveright) or haveyou vomited?

Fever

No fever

Have youexperienced

nausea and/orvomiting withthe headache?

Yes

No

ACTION


ACTION

TRY SELF-HELP MEASURESA mild headache iscommon following aminor head injury.

•Take an analgesic(not aspirin). CALL YOUR DOCTORIMMEDIATELYif your headache lastsfor more than 2 hoursor if you develop othersymptoms.

ACTION

TRY SELF-HELP MEASURESSinusitis is the likelycause of your headache.

•Try inhaling steamfrom a bowl of hotwater (p.165).CONSULT YOUR DOCTORif you feel no betterwithin 2 days.

START

HEADACHE 85

ACTION

CALL YOUR DOCTOR NOWYou have probably amigraine, particularlyif any visual problemsoccurred before theheadache. However,the slight chance of amore serious disorder,such as a stroke, needsto be ruled out if thisis your first migraine.

•Take an analgesicand sips of water.

•Rest in a darkened,quiet room until thepain subsides.If you have had anyprevious attacks, tryto identify and avoidpotential triggers, suchas chocolate.

The pain is feltchiefly in the

areas above andbelow the eyes

Neither

You have recentlyhad a runny or

stuffy nose


apply?

ACTION

CALL YOUR DOCTOR NOWAcute glaucoma (apainful, rapid risein fluid pressure in theeye) is a possibility,particularly if the painis around your eye.


Elsewhere

Where is thepain?

ACTION

CALL YOUR DOCTOR NOWYou may have temporalarteritis (inflammationof blood vessels in thehead), particularly ifyou are over 50 andare not feeling well.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour symptoms maybe side effects of themedication.


Have you hadthis type ofheadachebefore?

Yes

No

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR if you cannot identifya possible cause foryour headache fromthis chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR A recurrent headachefor which there is noobvious cause, suchas drinking too muchalcohol, should alwaysbe investigated fullyby your doctor.

Medication

No medication


Blurred vision

Unchanged

Disturbed inother ways

How is yourvision?

86

VertigoThe unpleasant sensation that your surroundingsare moving around you is known as vertigo. It isoften associated with nausea and vomiting. Healthypeople may experience vertigo temporarily after aride at an amusement park or after drinking toomuch alcohol. You should consult your doctor ifyou develop vertigo for no obvious reason.

!Recurring attacksof vertigoIf you have been experiencingattacks of vertigo, it is veryimportant to avoid certainactivities that are potentiallyhazardous to you and others.You should not climb laddersor steep flights of stairs,operate machinery, or driveuntil the cause of yoursymptoms has beendiagnosed and treated.

FAMILY ILLNESS

Have youexperiencedeither of thefollowing?

Nausea orvomiting

Difficultykeeping your

balance

NeitherACTION


a stroke.

ACTION

CALL YOUR DOCTOR NOWYou may have had amini-stroke.

ACTION

!DIAL 911 OR CALL EMSYou may have had a

stroke. Your symptomsmay also be caused bylabyrinthitis (inflamedinner ear).

•You can minimizethe symptoms oflabyrinthitis by lyingdown or trying tomove around as littleas possible.

Numbness,tingling, orweakness

Confusion

Difficultyspeaking

None of the above

Disturbed vision


START

Hearing loss

Neither

Ringing inthe ears

Have younoticed either ofthe following?

Symptomspresent


Are any of thesesymptoms still

present?

VERTIGO 87

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identify apossible cause for yourvertigo from this chart.

ACTION

CALL YOUR DOCTOR NOWYour symptoms maybe a side effect of yourmedication.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou could be sufferingfrom Ménière’s disease(a disorder of the innerear, which containsthe organs of balanceand hearing).

•Lie still in a darkenedroom with your eyesclosed and avoid noise.Acoustic neuroma(a noncancerous tumorof the nerve thatconnects the ear to thebrain) is another,although less likely,possibility.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour vertigo may becaused by osteoarthritisaffecting the bonesand cartilage of theupper spine (cervicalspondylosis). This cancause pressure on theblood vessels of theareas of the brain thataffect balance.

•Try to avoid makingany sudden or extremehead movements.

ACTION

TRY SELF-HELP MEASURESYour symptoms aremost likely to becaused by drinkingmore alcohol thanusual or drinking onan empty stomach.

•The effects ofalcohol should wearoff within a few hours.

•Meanwhile, drinkplenty of water. CONSULT YOUR DOCTORif the sensation persistsfor more than 12 hours.

50 or over

Under 50

How oldare you?

Yes

No

Have youbeen drinking

alcohol?

Medication

No medication


Does turningor raising yourhead bring on

vertigo?

Brings onvertigo

No noticeableeffect

88

Numbness and/or tinglingAlmost everyone has experienced numbness, theloss of sensation in a part of the body, after sittingor lying in an awkward position for some time.Tingling, a prickly feeling, often occurs as sensationreturns to a numb area. You should consult thischart if you experience numbness and/or tinglingfor which there is no obvious cause.

!

FAMILY ILLNESS

Did thenumbness

and/or tingling occur

in either of the following

circumstances?

After sitting in one positionfor a long time

On wakingfrom a

deep sleep

Neither

STARTACTION

TRY SELF-HELP MEASURESPressure on nerves oron the blood vesselsthat supply them isthe most likely cause.

•Change position andmassage the affectedarea. Normal sensationshould return within afew minutes. CONSULT YOUR DOCTORif the numbness ortingling feeling persistsfor longer than 1 hour.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have cervicalspondylosis (a type ofosteoarthritis thataffects the upper spine).

Danger signsDial 911 or call EMS if thenumbness and/or tingling isaccompanied by any of thefollowing symptoms:

•Feeling faint or passing out.

•Disturbed vision.

•Confusion.

•Difficulty speaking.

•Weakness in a limb.

Hand or arm

Elsewhere

Where is thenumbness

and/or tingling?

No stiff neck

Stiff neck

Numbness and/ortingling is worse

at night

Neither

Pain shootsinto palmof hand


apply?

Have younoticed anystiffness inyour neck?

NUMBNESS AND/OR TINGLNG 89

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may be sufferingfrom Raynaud’sphenomenon, in whichthere is intermittentnarrowing of bloodvessels in the hands or,rarely, the feet.

•Keep your handsand/or feet warm.

• If you smoke, stop.

ACTION


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour numbness and/ortingling from this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORThis type of numbnessis most likely causedby hand–armsyndrome, which isassociated with thelong-term use ofvibrating machinery.

•Avoid usingvibrating machinery.

•Keep warm.


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou probably havecarpal tunnel syndrome(tingling and pain inthe hand and forearmdue to a compressednerve at the wrist).

•Avoid positions thatworsen the symptoms.

Are the affectedareas on onlyone side of the body?

One side only

Both sides

Feeling faint or passing out

Confusion

Difficultyspeaking

Weakness in a limb

None ofthe above

Disturbed vision

Have you hadany of thefollowing

symptoms?

Do your fingersbecome numband white orblue in either

of the followingcircumstances?

In cold weather

When usingvibrating

machinery

Neither

ACTION


a stroke.

Are anyof these

symptomsstill present?

Symptomspresent


90 FAMILY ILLNESS

Facial pain


Elsewhere

In or aroundthe eye

Where is the pain?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may havetrigeminal neuralgia(severe pain due toan irritated nerve).

•Try to avoid triggersif possible.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOROR DENTISTYou may have adisorder in the jointbetween the jaw andthe skull.

•Take acetaminophen to relieve the pain.

•Hold a wrappedheating pad against theaffected area.

ACTION

GO TO ANOTHER CHARTEye pain orirritation, p.98

ACTION

CALL YOUR DOCTOR NOWYou may have temporalarteritis (inflammationof blood vessels aroundthe head), especially ifyou are over 50.

Stabbing painwhen touching

the face orchewing

Dull aching around one

or bothcheekbones

None ofthe above

Aching pain on chewing

and/or yawning

Which of thefollowingdescribes

your pain?

ACTIONTRY SELF-HELP MEASURESYou probably havesinusitis, especially ifyou have recently hada cold and both sides ofyour face are affected.If only one side isaffected, a dentalproblem, such as anabscess, is more likely.

•Take an analgesicsuch as acetaminophen.

•Try inhaling steamfrom a bowl of hotwater (p.165) if youthink you have sinusitis.CONSULT YOUR DOCTOROR DENTISTif you do not feelbetter within 2 days.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour facial pain fromthis chart.

START

Pain in the face may be sharp and stabbing or dulland throbbing, and is most often caused by aninflammation of structures in the face, such as thesinuses or teeth. Facial pain is usually short-lived,but some types, such as neuralgia, may persist.Consult your doctor if the pain is persistent,unexplained, or is not relieved by analgesics.

Your scalp issensitive to touch

Pain comes onwhen chewing

None ofthe above

You don’t feelwell

Do any of thefollowing

apply?

91FACIAL PAIN • DIFFICULTY SPEAKING

Difficulty speakingSlurred or unclear speech and the inability to findor use words are symptoms that may have anobvious cause, such as drinking too much alcohol.But difficulty speaking can also signal a moreserious condition affecting the brain’s speechcenters. If your speech suddenly deteriorates,consult your doctor urgently.

Disturbed vision


Confusion

Inability tomove the

muscles on oneside of the face

None ofthe above



START

ACTIONSEE YOUR DOCTORWITHIN 24 HOURSYour symptoms maybe a side effect ofmedication or drugs.


ACTIONSEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour speech difficultyfrom this chart.

ACTION

CALL YOUR DOCTOR NOWYou may have a typeof facial palsy, due todamaged facial nerves.

•Take care of youreyes, which may notclose fully.

ACTION


a stroke.

ACTION


ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORfor advice on reducingyour alcohol intake.

Symptomspresent


Are anysymptoms

still present?

You have beentaking drugs or

medication

You have asore mouthor tongue

None ofthe above

You have beendrinking alcohol

Do any ofthese apply?

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have glossitis(inflamed tongue).

•Rinse your mouthregularly with either a salt solution or apain-relievingmouthwash.

•Avoid acidic andspicy foods.


92

Forgetfulness or confusionMost people are forgetful sometimes, especiallyif they are very busy. Absent-mindedness is alsoa natural part of the aging process. Confusion isthe inability to think clearly and may includeforgetfulness. You should consult your doctor ifepisodes of forgetfulness and/or confusion occurfrequently or are severe enough to disrupt your life.

!Sudden onset ofconfusionCall a doctor immediately if a person suddenly becomesvery confused or disorientedabout time or place, or seemsto be seeing or hearingthings that are not there.

FAMILY ILLNESS

Has theforgetfulness

and/orconfusion

come on since a head injury?

Head injury

No head injury

ACTION

CALL YOUR DOCTOR NOWDamage to the brain,such as that resultingfrom a hard blow, maycause such symptoms.In some cases, theeffects may be delayed.

ACTION


ACTION

CALL YOUR DOCTOR NOWFever, especially atemperature that is over102°F (39°C), mayitself be a cause ofconfusion. However,confusion can also bedue to a number ofserious conditions,such as pneumonia.


ACTION


a stroke.

STARTDo you havea fever – a


or above?

Fever

No fever

Symptomspresent


Are any of thesesymptoms still

present?

Disturbed vision

Vertigo or lossof consciousness

Difficultyspeaking

None ofthe above



FORGETFULNESS OR CONFUSION 93

ACTION

CALL YOUR DOCTOR NOWLack of oxygen tothe brain caused bythe worsening of anexisting heart orlung disease maycause confusion.

ACTION

CALL YOUR DOCTOR NOWConfusion may indicatelow or very high bloodsugar levels in someonewith diabetes.

• Eat or drinksomething sugary now.

Diabetesmellitus

Lung disease

None ofthe above

Heart disease

Do you sufferfrom any of

the following?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORfor advice aboutreducing the amountof alcohol you drink.Drinking too muchalcohol can causeconfusion and, moreseriously, can also leadto loss of memory.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour symptoms maybe a side effect ofmedication or drugs.


Have you beendrinking alcoholwithin the past

few hours?

Yes

No

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORThese symptoms mayindicate a decline inmental function dueto a condition such asdementia. Depressionmay also causesimilar symptoms.

Personalitychange

Reducedattention to

personal hygiene

Inability to manageeverydayproblems

None ofthe above

Is graduallyincreasing

forgetfulnessand confusionin an elderly

personaccompaniedby any of the

following?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause for your forgetfulnessand/or confusion fromthis chart.

Medication

No medication


94

General skin problemsSkin problems are often caused by local infection,allergy, or irritation. They are usually not serious,although widespread skin problems may be distressing.You should consult your doctor if: a skin problemlasts more than a month or causes severe discomfort;a new lump appears, especially if it is dark-colored;or a sore fails to heal.

FAMILY ILLNESS

Rash

Other skinproblem

What type ofskin problemdo you have?



or above?

Fever

No fever

ACTIONGO TO ANOTHER CHARTRash with fever, p.96

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have cellulitis(infection of the skinand underlying tissue).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may possibly haveskin cancer.

ACTIONTRY SELF-HELP MEASURESThis may be a boil.

•Apply a hot cloth for30 mins, 4 times a day.CONSULT YOUR DOCTORif the condition has notimproved in 24 hours.

Itchy

Not itchy

Is the affected skin itchy?

Red, tender, andhot area of skin

New mole or achange in an existing mole

An open sore thathas not healedafter 3 weeks

None ofthe above


START

Painful, blisteryrash in one area

Reddenedpatches covered

with silvery scales

Blistery, oozingrash on or

around the lips

What does thearea look like?

A painful red lump with a

yellow center

None ofthe above

GENERAL SKIN PROBLEMS 95

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have psoriasis.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have a fungalinfection like ringworm.

ACTION

TRY SELF-HELP MEASURESYou may have a formof eczema.

• Follow the advicefor relieving itchiness(p.165). CONSULT YOUR DOCTORif your rash does notimprove within 1 week or if any othersymptoms develop.

ACTION

CALL YOUR DOCTOR NOWYour symptoms may bea side effect of the drug.


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause for your skin problemfrom this chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have Lymedisease, which iscarried by ticks.

ACTION

TRY SELF-HELP MEASURESYou may have beenbitten by an insect.

•Try using anantihistamine cream.

ACTION

TRY SELF-HELP MEASURESYou may have urticaria.

• Soothe the irritationwith cold compressesor calamine lotion.

•Try over-the-counterantihistamine tablets. CALL YOUR DOCTOR NOWif you are experiencingbreathing difficulties.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have shingles.

• Soothe the irritationwith cold compressesor calamine lotion.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have impetigo.

•Do not touch blisters.If you have had thesame problem before,it could be a cold sore.

•Use an over-the-counter antiviral cream.

Areas of inflamedskin with a scaly

surface

One or more redbumps with a

central dark spot

What does theaffected skin

look like?

None ofthe above

Merge intosurrounding skin

Clearly definedmargins

What do theedges of the

rash look like?

You have a rashthat spreadsout from a

central red spot

Neither

You have beenbitten by a tick


apply?

Medication

No medication


Intermittentred raised

areas (wheals)

96

Rash with feverFor rash without fever, see p.94

If you or your child has a temperature of 100.4°F(38°C) or above, you should check whether a rash is also present. A rash with fever is usually causedby a viral infection, most of which are not serious.However, a rash may alert you to the possibilityof potentially life-threatening meningitis.

!Danger signs Dial 911 or call EMS if a rashand fever are accompaniedby any of the following:


•Seizures.

•Temperature of 102°F(39°C) or above.

•Abnormally rapid breathing(see advice on checking yourchild’s breathing rate, p.71).

•Noisy or difficult breathing.

•Severe headache.

FAMILY ILLNESS

Widespread itchy,blistery rash

Flat, dark redspots that do

not fade whenpressed

Dull red spotsor blotches

that fade whenpressed

Bright red rash,particularly

on the cheeks

Pale pink rash ontrunk and/or face

None ofthe above

Rash that spreadsfrom a central

red spot

What are thefeatures of the

rash?START

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may havechickenpox, whichmay need treatmentwith an antiviral drug.


•Apply calaminelotion to relieve theitchiness of the rash.

ACTIONSEE YOUR DOCTORWITHIN 24 HOURS

You may have Lymedisease (an infectiontransmitted by ticksthat causes a rash andflulike symptoms).


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSFifth disease (orslapped cheek disease)due to a parvovirusinfection may be thecause in a child.

• Follow the advicefor bringing down afever (p.164).ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour rash and feverfrom this chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have rubella(German measles).Roseola infantum (a viral infection thatcauses high feverfollowed by a rash oftiny pink spots) isanother possibility,particularly in childrenunder 4 years old.


•Warn any contactyou think couldbe pregnant.

RASH WITH FEVER 97

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have measles,which is a potentiallyserious illness.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause for your rash and feverfrom this chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have a viralillness, but scarletfever is a possibility.


Severeheadache

Dislike ofbright light

Neck pain whenbending head

forward

Nausea orvomiting

None ofthe above



Have younoticed any ofthe following

symptoms in thepast few days?

Runny nose

Cough

Red eyes

None ofthe above

Yes

No

Do you havea severe

sore throat?

ACTION


meningitis (inflamedmembranes around the brain).

ACTION

CALL YOUR DOCTOR NOWThis type of rash maybe due to a severeallergic reaction to adrug such as penicillin.It could also be theresult of a blooddisorder that causesbleeding into the skin.


Checking a red rashIf you develop a dark red rash,check if it fades on pressure bypressing the side of a drinkingglass onto it. If the rash isvisible through the glass, itmay be a form of purpura, arash caused by bleeding fromtiny blood vessels in the skineither because blood vesselsare damaged or because ofan abnormality in the blood.Purpura can be caused by oneof several serious disorders,including meningitis, and needsprompt medical attention. Dial911 or call EMS if you have ahigh fever, severe headache,or any of the other dangersigns listed opposite.

98

Eye pain or irritationInjury, infection, and allergy are the most commoncauses of discomfort or irritation of the eye andeyelids. A painless red area in the white of the eye islikely to be a burst blood vessel and should clear upwithout treatment. However, you should see yourdoctor if your eyes are sore. Consult your doctorimmediately if your vision deteriorates.

!Contact lens wearersIf you wear contact lensesand experience any kind ofeye pain or irritation:

•Remove your lenseswithout delay.

•Do not use them againuntil the problem has beenidentified and treated. If thepain is caused by grit underthe lens, there is a risk thatthe cornea will be scratched.

•Make an appointment tosee your ophthalmologist.

FAMILY ILLNESS

ACTION

CALL YOUR DOCTOR NOWYour pain may becaused by a minor eyeinjury.

• Follow the first-aidadvice for dealing witheye wounds (p.35).

ACTION

!DIAL 911 OR CALL EMSA serious eye injury

is possible. Experthelp may be neededto prevent permanentdamage to the eye.

ACTION

TRY SELF-HELP MEASURESA foreign object inyour eye is likely tocause pain and redness.

• Follow the first-aidadvice for dealing witha foreign object in theeye (p.36). SEEK EMERGENCY HELPAT THE HOSPITALif a foreign object isembedded in the eye.

ACTION

TRY SELF-HELP MEASURESYou may have a stye(infected hair follicle)or a chalazion (infectedgland in the eyelid).

•Hold a clean, warm,damp cloth on theeyelid for 20 minutesseveral times a day.CONSULT YOUR DOCTORif your eye does notimprove within 3 days.

Pain in andaround the eye

Tender redlump on the

eyelid

The eyefeels gritty

None ofthe above

Itching orirritation ofthe eyelid

What isthe main

symptom?

You havesomething in

your eye

You have injured your eye


apply?

Neither

START

Yes

No

Has your visiondeteriorated

since the injury?

EYE PAIN OR IRRITATION 99

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have so-calledcluster headaches oruveitis (inflammationof the iris), especiallyif the eye is red and/or watery.

•Take an analgesicsuch as acetaminophento relieve symptoms.

•Rest in a quiet,darkened room.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identify apossible cause for youreye pain or irritationfrom this chart.

ACTION

CALL YOUR DOCTOR NOWYou may have acuteglaucoma (painful,rapid rise in fluidpressure in the eye),which could damagevision permanently.

ACTION

TRY SELF-HELP MEASURESYou may haveblepharitis (inflamedeyelid), especially ifthe skin is scaly andinflamed.

•Relieve symptoms byholding a warm, dampcloth on the eyelid.

• If you have dandrufftoo, using an antifungalshampoo will improveboth conditions.CONSULT YOUR DOCTORif self-help measuresdo not help.

Blurred

Not blurred

Is your visionblurred?

Eyelid turnedinward

Appears normal

Eyelid turnedoutward

Is your eyelid turned inward or outward?

Waterydischarge

No discharge

Sticky discharge

Is there anydischarge from

the eye?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOREntropion (turninginward of the upper orlower eyelid, or both)is a possible cause ofyour symptoms.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOREctropion (turning outof the lower eyelid) isa possible cause ofyour symptoms.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou probably haveconjunctivitis (inflamedmembrane coveringthe eye).

•Wipe the dischargeaway from your eyewith clean, moistcotton.

•Use artificial tears,available over thecounter, to relievesymptoms.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may havekeratoconjunctivitissicca (dry eye), inwhich the eye fails toproduce enough tears.

•Use artificial tears,available over thecounter, to relievesymptoms.

100

Disturbed/impaired visionVisual disturbances might include blurred vision orseeing double. You may also see flashing lights orfloating spots. These disturbances may be caused bya problem in one or both eyes or by damage to theareas in the brain that process visual information.If your vision deteriorates suddenly, you shouldconsult your doctor immediately.

FAMILY ILLNESS

Pain

No pain

Do you havepain in the

affected eye?

Yes

No

Do you havediabetes?

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSDamage to bloodvessels in the retinadue to diabetes or highblood sugar levels canlead to blurred vision.

ACTION

GO TO ANOTHER CHARTEye pain or irritation,p.98

ACTION


damaged the partof the brain that isresponsible for vision.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORA cataract (clouding ofthe lens of the eye) cancause blurred vision inolder people.

How long hasyour vision

been disturbed or impaired?

Less than24 hours

24 hours or longer

50 or over

Under 50

How oldare you?

START

Blurred vision

Increasingdifficulty infocusing on

nearby objects

Otherdisturbance

What kindof visual

disturbance orimpairment

have you beenexperiencing?

Recent headinjury

No head injury

Have you injuredyour head in thepast 48 hours?

DISTURBED/IMPAIRED VISION 101

ACTION


blockage of a bloodvessel that supplies thebrain or eye. Anotherpossibility is a detachedretina, which needsprompt treatment.

ACTION

!DIAL 911 OR CALL EMSThis may be due to

bleeding in the brain,such as with a strokeor subarachnoidhemorrhage (rupturedartery near the brain).Another possibility is aweakness or paralysisof the muscles thatcontrol the movementof the eyes, causingdouble vision.

ACTION

MAKE AN APPOINTMENTTO SEE YOUROPHTHALMOLOGIST

You may be developingpresbyopia (gradualloss of the eyes’ abilityto focus on nearobjects).

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour disturbed orimpaired vision fromthis chart.

ACTION

CALL YOUR DOCTOR NOWif you cannot identifya possible cause foryour disturbed orimpaired vision fromthis chart.

ACTION

CALL YOUR DOCTOR NOWYou may have amigraine. However,the possibility ofanother disorder needsto be ruled out.

•Rest in a darkenedquiet room untilsymptoms improve.

• If you also havea headache, take ananalgesic such asacetaminophen.CONSULT YOUR DOCTORif you have hadprevious migraines.

•Avoid red wine,chocolate, and maturecheese – all possiblemigraine triggers.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour symptoms maybe a side effect of themedication.


What is thenature of yourdisturbed or

impaired vision?

Sudden loss of allor part of the

vision in one orboth eyes

Blurred vision

Seeing flashinglights or

floating spots

Double vision

None of the above

Medication

No medication


102 FAMILY ILLNESS

EarachePain in one or both ears is a distressing symptom,especially for children. Earache is usually causedby an infection in the outer or middle ear. Milddiscomfort, however, may be due to wax blockage.Consult your doctor if you suffer from earache,particularly if it is persistent. A severe or recurrentmiddle-ear infection may damage hearing.

Does pullingthe earlobemake the

pain worse?

Increases pain

Pain is no worse

Is therea discharge

from theaffected ear?

Discharge

No discharge

ACTION

TRY SELF-HELP MEASURESA cold may often beaccompanied by mildearache. Persistent orsevere earache is likelyto be due to otitis media(middle-ear infection).

•Take a decongestantto relieve stuffiness andan analgesic, such asacetaminophen, torelieve discomfort.CONSULT YOUR DOCTORif the pain is severeor if it persists forlonger than 2 days.

STARTACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour earache isprobably due to otitisexterna (infection ofthe outer ear) or a boilin the ear canal.


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif the discomfortpersists for longer than24 hours. Barotrauma(ear damage or paincaused by pressurechanges) may be thecause of your pain.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have otitismedia (middle-earinfection) with aperforated eardrum;otitis externa (outer-ear infection) isanother possibility.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identify apossible cause for yourearache from this chart.

Did the painstart during or

immediatelyafter an airplane

flight?

During orimmediatelyafter flight

Unrelated toair travel

Yes

No

Do you havea runny or

stuffy nose?

103EARACHE • SORE THROAT

Sore throatA raw or rough feeling in the throat is a symptomthat most people have from time to time. A sorethroat is often the first sign of a common cold and isalso a feature of other viral infections. You can treata sore throat yourself at home unless you also haveother, more serious symptoms. However, if yoursore throat persists or is severe, consult your doctor.

ACTION

TRY SELF-HELP MEASURESActivities such assmoking or breathingsmoke, shouting, andloud singing are likely tocause throat irritation.

• Follow the advicefor soothing a sorethroat (p.164).CONSULT YOUR DOCTOR if your symptomsworsen, change, or areno better in 2 days.

ACTIONTRY SELF-HELP MEASURESYou probably havea severe cold or flu.

• Follow the advicefor bringing down afever (p.164).CONSULT YOUR DOCTORif your symptomsworsen, change, or areno better after 2 days.

ACTIONTRY SELF-HELP MEASURESYou may have a cold.

• Follow the advicefor soothing a sorethroat (p.164).CONSULT YOUR DOCTOR if you are no betterwithin 2 days.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have eithertonsillitis or pharyngitis(inflamed throat).

•Follow the advicefor soothing a sorethroat (p.164).

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may be sufferingfrom infectiousmononucleosis.



or above?

Fever

No fever

Do you haveswelling in your

groin and/orarmpits ?

Yes

No

Before the onsetof your sore

throat, had youbeen doing any

of these?

Smoking heavilyor breathing

smoke

Shouting orsinging loudly

None ofthe above

START General aches and pains

Headache

Cough

None of the above

Runny nose

Do you haveany of these?

104

Hoarseness or loss of voiceThe sudden onset of hoarseness or huskiness of thevoice is a common symptom of upper respiratorytract infections that involve the larynx or vocalcords. Such infections are almost always caused byviruses. Hoarseness and loss of voice that developgradually are most commonly caused by overuse ofthe voice, smoking, or, rarely, cancer of the larynx.

!Persistent changein the voiceIt is important to seekmedical advice if you develophoarseness or any other voicechange that lasts for morethan 2 weeks, since the slightpossibility of cancer of thelarynx needs to be ruled out.

FAMILY ILLNESS

How longago did the

hoarseness orloss of voice

develop?

Over a week ago

Within the past week

Do you use yourvoice a lot; forexample, areyou a singer or teacher?

Normal voice use

Regular loud voice use

Have you hadany of thefollowing

symptoms in thepast week?

Runny noseand/or sneezing

Cough

Sore throat

None of the above

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORRegular overuse ofyour voice can leadto chronic laryngitisor vocal cord nodules(small, noncancerouslumps found on thevocal cords).


•Try inhaling steamfrom a bowl of hotwater (p.165) to relieveyour hoarseness.

•Rest your voice asmuch as possible.

ACTION

TRY SELF-HELP MEASURESYou probably haveacute viral laryngitis.



•Rest your voice asmuch as possible.CONSULT YOUR DOCTORif you do not feelbetter within 2 daysor if any othersymptoms develop.

Before the onsetof hoarseness,had you been

using your voicemore than usual?

More voice use than usual

Normal voiceuse

START

Did either ofthe followingapply before the onset ofhoarseness?

HOARSENESS OR LOSS OF VOICE 105

You inhaled dust,chemical fumes,

or smoke from a fire

You spent time in a smoky

atmosphere

Neither

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORHeavy smoking over along period of timecan result in laryngitis.• If you smoke, stop.

•Rest your voice asmuch as possible. Another possibility iscancer of the larynx,which is more commonin regular smokers.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour hoarseness or lossof voice from this chart.

ACTION

TRY SELF-HELP MEASURESExcessive use of thevoice can inflame thevocal cords.



•Rest your voice asmuch as possible. CONSULT YOUR DOCTORif your voice is nobetter within 2 daysor if any othersymptoms develop.

ACTION

TRY SELF-HELP MEASURESBeing in a smokyatmosphere can inflamethe vocal cords.



•Rest your voice asmuch as possible. CONSULT YOUR DOCTORif your voice is nobetter within 2 daysor if any othersymptoms develop.

Do you smoke,or have you

smoked in thepast?

Yes

No

ACTION

CALL YOUR DOCTOR NOWBreathing in dust,fumes, or smoke caninflame the airways.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORHypothyroidism(underactivity of thethyroid gland) cancause a husky voice.


Fatigue

Increased skindryness orroughness

Feeling the cold more than

you used to

Unexplainedweight gain

General hairthinning

None of the above

106

Coughing (adults)For children under 12, see p.108A natural defence mechanism, coughing is the body’sway of clearing the airways of inhaled particles orsecretions. Persistent coughing may be due to infectionor inflammation in the lungs or to the effects ofirritants such as tobacco smoke. Persistent coughingshould be investigated by your doctor.

!Coughing up bloodIf you cough up sputum thatcontains streaks of blood onone occasion only, the mostlikely cause is a small tear inthe lining of the windpipe; ifyou feel well, you need notbe concerned. However, ifyou have more than one suchepisode, there may be a moreserious cause; you should seea doctor without delay.

FAMILY ILLNESS

Less than48 hours

Over 48 hours

How longhave you had

a cough?

Sputum

No sputum

Are youcoughing up

sputum?

STARTDo you havea fever – a


or above?

Fever

No fever

Are youcurrently takingany prescribed

medication?

Medication

No medication

ACTION


•Continue to takethe medication unlessadvised to stop byyour doctor.

ACTION

TRY SELF-HELP MEASURESA cough is the body’sway of clearing thelungs.CONSULT YOUR DOCTOR

if your cough continuesfor more than 1 hour.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have asthmaor another chroniclung disorder. Lungcancer is unlikely butshould be ruled out.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identify apossible cause for yourcough from this chart.

Smoker

Nonsmoker

Are you a smoker?

COUGHING (ADULTS) 107

Sputum

No sputum

Have youcoughed up

sputum?

Runny nose

Sore throat

Neither


ACTION

TRY SELF-HELP MEASURESYou may have acutebronchitis.

•Take acetaminophento reduce your feverand chest pain.

•Drink plenty of fluids.

• If you smoke, stop. CONSULT YOUR DOCTORif your symptomsworsen or if you areno better within 2 days.

ACTION

TRY SELF-HELP MEASURESYou may have a viralillness such as a severecold or flu.


•Try inhaling steamfrom a bowl of hotwater (p.165) to relieveyour symptoms.MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are no betterin 2 days or if othersymptoms develop.

ACTION

TRY SELF-HELP MEASURESYou probably have aviral infection, suchas a cold.

•Try inhaling steamfrom a bowl of hotwater (p.165) to relieveyour symptoms.MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are no betterin 2 days or if othersymptoms develop.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAsthma or possiblyheart failure may bethe cause of yoursymptoms.


ACTION

TRY SELF-HELP MEASURESSmoke can irritate the lungs.

•Move into a well-ventilated area.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have chroniclung damage fromsmoking or possiblylung cancer.

• Stop smoking.

Pain onbreathing

Neither

Shortness of breath


ACTION

CALL YOUR DOCTOR NOWYou may havepneumonia.

•Take acetaminophento help reduce yourfever and pain.

ACTIONCALL YOUR DOCTOR NOWInflammation of theairways can resultfrom breathing in anyof these substances.

Have youinhaled any of

these in the lastfew hours?

Particle of food

Tobacco smoke

Dust, fumes, orsmoke from a fire

None of the above

108

Coughing (children)

For adults and children over 12, see p.106Coughing is a normal reaction to irritation in thethroat or lungs. Most coughs are due to minorinfections of the nose and/or throat, but a suddenonset of coughing may be caused by choking.Coughing is unusual in babies less than 6 monthsold and may indicate a serious lung infection.

!Danger signsDial 911 or call EMS if yourchild is coughing and has anyof the following symptoms:

•Blue-tinged lips or tongue.


• Inability to produce sounds.

• Inability to drink.

•Excessively rapid breathing.

FAMILY ILLNESS

Startedsuddenly a few

minutes ago

Started morethan a few

minutes ago

How long hasyour child been

coughing?START

ACTION

TRY SELF-HELP MEASURESAn inhaled object maybe the cause of thecoughing. Follow thefirst-aid advice forchoking (pp.22–24).

!DIAL 911 OR CALL EMSif the object is not

dislodged immediately.

Under 6 months

6 monthsor over

How old isyour child? ACTION

CALL YOUR DOCTOR NOWYour baby may havea serious lung infectionsuch as bronchiolitis(inflamed smallairways in the lungs).

•Keep your babysitting up, if possiblein a steamy bathroom.

ACTION

GO TO ANOTHER CHARTBreathing problems(children), p.112

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child mayhave pertussis(whooping cough).

Does the coughhave either

of thesecharacteristics?

Comes in fitsending with

a whoop

Is accompaniedby vomiting

Neither

Is it possible thatyour child is

choking on foodor a small object?

Possible

Unlikely

Is your child’sbreathing

abnormallyrapid or noisy

(see p.71)?

Abnormally rapid

Noisy

Neither

COUGHING (CHILDREN) 109

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour child’s coughfrom this chart.

ACTION

TRY SELF-HELP MEASURESYour child’s coughmay be a responseto being in a smokyatmosphere or to hisor her own smoking.

•Make sure that noone smokes in thehouse and avoidtaking your child intoa smoky atmosphere.

• If you suspect thatyour child may besmoking, encouragehim or her to stop.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child’s symptomsmay be due to asthma.

•Discourage yourchild from activitiesthat provoke coughing.

•Avoid unnecessaryexposure to dust,pollen, or animal fur.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour child may havean allergy or possiblyenlarged adenoids.

Most of the timeor very often

No runny nose

Has developeda runny nose

within the pastfew days

Does yourchild have arunny nose?

Mainly at night

When out inthe cold

None ofthe above

After exercise

When doesthe coughing

occur?

Does your childhave a fever – a temperature

of 100.4°F (38°C)or above?

Fever

No fever

Are theresmokers in thehome or mightyour child havebeen smoking?

Smokers inthe home

Child mightsmoke

Neither

ACTION

TRY SELF-HELP MEASURESYour child probablyhas a viral illness, suchas a cold or flu.


•Try inhaling steamfrom a bowl of hotwater (p.165) or sittingin a steamy bathroom.CONSULT YOUR DOCTORif symptoms worsen, ifyour child is no betterin 2 days, or if othersymptoms develop.

ACTION

TRY SELF-HELP MEASURESYour child probablyhas a cold.

•Try inhaling steamfrom a bowl of hotwater (p.165) or sittingin a steamy bathroom. CONSULT YOUR DOCTORif symptoms worsen, ifyour child is no betterin 2 days, or if othersymptoms develop.

110

Shortness of breath (adults)For children under 12, see p.112Feeling short of breath is to be expected after strenuousexercise. Breathing should return to normal afterresting. If you are short of breath at rest or followingnormal activities, such as getting dressed, youshould consult your doctor because your symptommay be due to a serious heart or lung disorder.

!Danger signsDial 911 or call EMS if eitheryou or someone you arewith has one or both ofthe following symptoms:

•Sudden and severeshortness of breath.

•Blue-tinged lips. While waiting for medicalhelp, loosen any restrictingclothing and help theperson sit upright.

FAMILY ILLNESS

Painful

Not painful

Is breathingpainful?START

Wheezing

No wheezing

Have you beenwheezing?

Gradually, over a few days

or longer

Suddenly, within the past

48 hours

How quickly didthe shortness of

breath start?

ACTION

GO TO ANOTHER CHARTWheezing, p.114

ACTION

!DIAL 911 OR CALL EMSYou may have a

pulmonary embolism(blood clot in the lung).

ACTION

GO TO ANOTHER CHARTChest pain, p.134

Swollen ankles

Neither

Cough withsputum on most days



apply?

You have recentlybeen immobiledue to injury or

a long trip

You have had ababy within the

past 2 weeks

None ofthe above

You have recentlyhad surgery

Waking atnight feeling

breathless

Frothy pink or white sputum

Temperature of 100.4°F

(38°C) or above

None ofthe above


SHORTNESS OF BREATH (ADULTS) 111

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have chronicheart failure, whichcauses fluid to gather inthe lungs and tissues.

•If you smoke, stop.

•Avoid strenuousexercise and stressfulsituations.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have chronicbronchitis or lungdamage from smoking.


•Avoid exposure tosmoke, pollution, dust,dampness, and cold.

•Exercise lightly.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have lungdisease caused byinhaling damagingdusts or gases.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haveinflammation of thelungs due to an allergy.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may be anemic,but a blood test willbe needed to confirmthe diagnosis.

•Get plenty of rest.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour shortness ofbreath from this chart.

ACTION

CALL YOUR DOCTOR NOWYou may have a lunginfection, such aspneumonia, especially ifyou also have a cough.

•Take acetaminophento reduce fever.

ACTION

CALL YOUR DOCTOR NOWYou may have had apanic attack, but thisneeds to be confirmedby a doctor.

• If you have hadsuch attacks before,breathing into a bagmay relieve symptoms(p.168).

ACTION

CALL YOUR DOCTOR NOWYou may have fluid onthe lungs (pulmonaryedema) caused byacute heart failure.

Do you have, orhave you everhad, regular

exposure to orcontact with the

following?

Dust or fumes

Grain crops,caged birds,or animals

Neither

Did theshortness ofbreath start

straight after astressful event?

Yes

No

Faintness orfainting

Undue fatigue

None ofthe above

Paler skinthan normal


112

Breathing problems (children)For adults and children over 12, see p.110

Noisy or rapid breathing and shortness of breathindicate breathing problems. Such problems may not be obvious in children, who may simply avoidexertion. A child with severe difficulty breathingneeds urgent hospital treatment. Breathing problemsthat occur suddenly also need immediate attention.

!Danger signsDial 911 or call EMS if yourchild’s breathing rate isexcessively rapid (see adviceon checking your child’sbreathing rate, p.71) and if breathing problems areaccompanied by any of thefollowing symptoms:

•Blue-tinged lips or tongue.


• Inability to swallow, talk,or produce sounds.

FAMILY ILLNESS

How long hasyour child had

breathingproblems?

Startedsuddenly, a few

minutes ago

Started morethan a few

minutes ago

STARTIs it possible

that your childis choking on

food or a smallobject?

Possible

Unlikely

Are any of thedanger signslisted in thebox abovepresent?

Danger signspresent

No danger signs

ACTION


a serious respiratoryproblem.

• If your child stopsbreathing, follow thefirst-aid advice forgiving rescue breaths(pp.16–17).

ACTION

TRY SELF-HELP MEASURESAn inhaled object maybe causing difficultybreathing. Follow thefirst-aid advice forchoking (pp.22–24).

!DIAL 911 OR CALL EMSif object is not

dislodged immediately.

ACTION

CALL YOUR DOCTOR NOWThe cause of thesesymptoms could be aserious lung infectionsuch as bronchiolitis(inflamed smallairways in the lungs).

•Keep your babysitting up, if possiblein a steamy bathroom.

Under 6 months

6 monthsor over

How old isyour child?

BREATHING PROBLEMS (CHILDREN) 113

ACTION

CALL YOUR DOCTOR NOWYour child may have alung infection, such aspneumonia. Anotherpossible cause isbronchiolitis (inflamedsmall airways in thelungs), particularlyin young children.

•Give your childliquid acetaminophento reduce fever.

•Offer frequent drinks.

• Increase the humidityin your child’s room byputting a bowl of waternear a radiator.

ACTION

CALL YOUR DOCTOR NOWThese symptoms maybe due to croup(inflammation of thewindpipe).

• Sit with your childin a steamy bathroomto relieve breathingdifficulties.

•Encourage your childto drink plenty of fluids.

•Ensure that yourchild sits quietly andavoids exertion.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child may havedeveloped asthma.

•Keep your childrested and warm.

•Minimize contactwith any possibletriggers, such as dust,pollen, or animal fur.

•Avoid exposing yourchild to smoke.

•Avoid using perfumeand air fresheners.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause forthe breathing problemsfrom this chart.

Noisy breathing

Shortness of breath

None ofthe above

Barking cough

Does your childhave any of

the following?

Does your childhave a fever –a temperature

of 100.4°F (38°C)or above?

Fever

No fever

Does yourchild suffer

from repeatedepisodes ofany of thefollowing?

Wheezing

Coughing at night

Coughing afterexercise

Coughing aftergoing out in

the cold

None ofthe above

114 FAMILY ILLNESS

WheezingFor children under 12, see p.112

A whistling or rasping sound on exhaling occurswhen the air passages become narrowed. The mostcommon causes are inflammation due to infection,asthma, or inhaled dust. In rare cases, a narrowingof the airways may be due to a tumor. If you havepersistent wheezing, you should see your doctor.

Most days

Seldom or never

Do you coughup sputum?

Short of breath

Not shortof breath

Are you shortof breath?

Has thewheezing come

on suddenlywithin the pastfew hours or

gradually overdays or weeks?

Sudden onset

Gradual onset

START

Frothy pink orwhite sputum

Waking atnight feeling

breathless

Neither


ACTIONCALL YOUR DOCTOR NOWThere is a possibilityof fluid on the lungscaused by heart failure.

ACTION

CALL YOUR DOCTOR NOWYou could be havingan asthma attack.

• If you have a relieverinhaler, use it now.

• Stay calm and sit ina comfortable position.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURS You may be havinga mild asthma attack.

•Use a reliever drugif you have one.

•Try to avoid pollutedor smoky atmospheres.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYour symptoms maybe caused by chronicbronchitis or lungdamage from smoking.

ACTIONSEE YOUR DOCTORWITHIN 24 HOURSif you cannot identify apossible cause for yourwheezing from this chart.

ACTIONSEE YOUR DOCTORWITHIN 24 HOURSYou may have acutebronchitis.

•Take acetaminophento reduce your fever.




or above?

Fever

No fever

115WHEEZING • DIFFICULTY SWALLOWING

Difficulty swallowingAny difficulty swallowing is usually the result of asore throat due to infection. Self-treatment shouldease the soreness and allow normal swallowing.However, persistent difficulty swallowing may bedue to a disorder of the stomach or esophagus, thetube connecting the throat to the stomach, andshould be investigated by your doctor.

ACTION

CALL YOUR DOCTOR NOWSomething may haveeither scratched yourthroat or becomelodged in it.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAnxiety disordersmay be a cause ofthis type of difficultyswallowing.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou probably have aninflamed esophagusdue to acid reflux.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have anarrowed esophaguscaused by acid reflux,but cancer of theesophagus is possible.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identify apossible cause for yourdifficulty swallowingfrom this chart.

Sore

Not sore

Is yourthroat sore?START

Is it possiblethat you have

swallowedsomething

sharp, such asa fish bone?

Possible

Unlikely

Do you get aburning painin the center

of the chest ineither of these

situations?

When youbend forward

When youlie down

NeitherFood seems to stick high up in

the chest

Neither

You have a feeling of

something beingstuck in the throat

Which of thefollowingapplies?

ACTION


The difficultyswallowing isgetting worse

Neither

You havelost weight


apply?

116

Vomiting (adults)For children under 12, see p.118Irritation or inflammation of the digestive tract is themost common cause of vomiting. But vomiting mayalso be triggered by conditions affecting the brain or by an inner-ear disorder, or it can be a side effectof medication. If you suffer from frequent episodes of vomiting, you should consult your doctor.

!Danger signsDial 911 or call EMS if yourvomit contains blood, whichmay appear in any of thefollowing forms:

•Bright red streaks.

•Black material thatresembles coffee grounds.

•Blood clots.

FAMILY ILLNESS

Have yousuffered fromother episodesof vomiting?

Previousepisodes

Single episode

Severe pain

No pain

Mild pain

Do you havepain in theabdomen?

ACTION

CALL YOUR DOCTOR NOWYou could have aserious abdominalcondition, such asappendicitis.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have adigestive tract disorder.

Eye pain

No eye pain

Do you havepain in or

around an eye?

ACTION

CALL YOUR DOCTOR NOWYou may have acuteglaucoma (a painful,rapid rise in fluidpressure in the eye),especially if yourvision is also blurred.

ACTION

!DIAL 911 OR CALL EMSYou may have had a

stroke. Your symptomsmay also be caused bylabyrinthitis (inflamedinner ear).

•You can minimizethe symptoms oflabyrinthitis by lyingdown or moving aslittle as possible.

Headache

No headache

Do you havea headache?

Temperature of100.4°F (38°C)

or above

Dizziness

None of the above

Diarrhea


START

VOMITING (ADULTS) 117

ACTION

GO TO ANOTHER CHARTHeadache, p.84

ACTION

TRY SELF-HELP MEASURESYou may have a caseof gastroenteritis.

• Follow the advicefor preventingdehydration (p.165). CONSULT YOUR DOCTORif you are no betterin 2 days or if othersymptoms develop.

ACTION

TRY SELF-HELP MEASURESYou may have foodpoisoning.

• Follow the advicefor preventingdehydration (p.165). CONSULT YOUR DOCTORif you are no betterin 2 days or if othersymptoms develop.

ACTION



ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause for your vomiting fromthis chart.

ACTION

TRY SELF-HELP MEASURESYou probably havegastritis (inflammationof the stomach lining).

•Take over-the-counterantacids to neutralizethe acid in the stomach.

•Eat small meals atregular intervals.

• Stop drinking alcoholuntil you are better.

• If you smoke, stop.CONSULT YOUR DOCTORif you are no betterin 2 days or if othersymptoms develop.

!Vomiting andmedications If you are taking any oralmedication, including oralcontraceptives, an episodeof vomiting may reducethe effectiveness of thedrug because your bodycannot absorb the activeingredients. If you use oralcontraceptives, you willneed to use an additionalform of contraception suchas condoms for some timeafter the vomiting hasstopped. Follow theinstructions provided withthe oral contraceptives orconsult your doctor if youare not sure what to do.You should also see yourdoctor if you are taking anyother prescribed medicineand have been vomiting.

Have youeaten or drunk

any of thefollowing?

An unusuallylarge or

rich meal

A large amount of

alcohol

Food that mayhave been

contaminated

None of the above

Medication

No medication


118

Vomiting (children)For adults and children over 12, see p.116

Children vomit as a result of many illnesses,including ear infections and urinary and digestivetract disorders. Anxiety or excitement may alsocause vomiting. Rarely, vomiting may be due toan infection or injury to the brain. If vomiting ispersistent, consult your child’s doctor urgently.

!Danger signsDial 911 or call EMS ifyour child’s vomiting isaccompanied by any ofthe following symptoms:

•Greenish yellow vomit.

•Abdominal pain for 4 hours.

•Flat, dark-red or purplespots on skin that do notfade when pressed.

•Refusal to drink or feed (in babies) for over 6 hours.


•Sunken eyes.

•Dry tongue.

•Not urinating duringthe day for 3 hours (if childis under 1 year old) or 6hours (in an older child).

•Black or bloodstained feces.

FAMILY ILLNESS

Head injury

No head injury

Has your childhad a recenthead injury?

Severeheadache


Pain whenbending neck

None ofthe above



the following?

ACTION


meningitis (inflamedmembranes aroundthe brain).

ACTION


a concussion.

•Do not allow yourchild to eat or drink.

ACTION

CALL YOUR CHILD’SDOCTOR NOW

These symptoms mayindicate a seriousabdominal condition. ACTION

CALL YOUR CHILD’SDOCTOR NOWThese symptoms mayhave numerous causes.However, any infantunder 3 months whodoes not seem well andvomits needs promptmedical attention.

Under 3 months

3 months or over


Yes

No

Does your childseem to have

abdominal pain?

START

Apart from thevomiting, is yourbaby generally

not well, i.e.feverish ordrowsy?

Not well

Well

VOMITING (CHILDREN) 119

ACTION

CALL YOUR CHILD’SDOCTOR NOW Yourchild may have a lunginfection such aspertussis, bronchiolitis,or pneumonia.

ACTION

BRING YOUR CHILD TOTHE DOCTOR WITHIN24 HOURS This type ofvomiting in an infantmay be the result of adigestive tract problem,such as pyloric stenosis,in which the stomachoutlet becomesabnormally narrowed.

ACTION

BRING YOUR CHILD TOTHE DOCTOR WITHIN 24HOURS He may have aurinary tract infection.

•Give plenty of fluidsto drink.

ACTION

BRING YOUR CHILD TOTHE DOCTOR WITHIN24 HOURS Your childmay have an infectionsuch as acute otitismedia (an infection ofthe middle ear) or aurinary tract infection.

•Give liquidacetaminophen torelieve pain and fever.

ACTION

BRING YOUR CHILD TOTHE DOCTOR WITHIN24 HOURS if you cannotidentify a cause foryour child’s vomitingfrom this chart.

ACTION

TRY SELF-HELP MEASURESBabies often vomit forno particular reason. Itis no cause for concernif the baby seems welland is gaining weight.

•Be sure to burp yourbaby after each feeding. CONSULT YOUR CHILD’SDOCTOR if your babyseems sick or vomitsfrequently.

ACTION

TRY SELF-HELP MEASURESThis type of vomitingis rarely serious and hasseveral possible causes.

•Always burp yourbaby after feeding. CONSULT YOUR CHILD’SDOCTOR if your infantdoes not seem well oris failing to gain weight.

ACTION

CALL YOUR CHILD’SDOCTOR NOW if yourchild is under 6 monthsold. He may have acase of gastroenteritis.

•Make sure olderchildren drink plentyof clear fluids.CONSULT YOUR CHILD’SDOCTOR if your child isno better within 24hours or if any othersymptoms develop.

Diarrhea

No diarrhea

Does yourchild havediarrhea?

Pain whenurinating


(38°C) or above

None ofthe above

Renewed bedwettingor daytime“accidents”


the following?

Followedcoughing

No coughing

Did vomitingfollow violent

coughing?

Frequent andeffortless after

feeding

Occasional, notassociated with

feeding

Forceful afterseveral feedings

What are thecharacteristics of

the vomiting?

120

Abdominal pain (adults)For children under 12, see p.124Mild abdominal pain is often due to a stomach orbowel upset that will clear up without treatment.However, severe or persistent abdominal pain,especially if it is accompanied by other symptoms,may indicate a more serious problem that shouldbe investigated by your doctor.

!Danger signsDial 911 or call EMS if youhave severe abdominal painthat lasts for longer than4 hours and is associatedwith any of the followingadditional symptoms:

•Vomiting.

•Fever.

•Swollen or tender abdomen.

•Feeling faint, drowsy, orconfused.

•Blood in the urine or feces.

FAMILY ILLNESS

Have you hadmore than

one episode of pain?

Singlecontinuous

episode

Recurrentepisodes

START

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have a urinarytract problem or adigestive tract disorder.

ACTION


serious abdominalcondition, such asappendicitis.

ACTION

TRY SELF-HELP MEASURESYou may have a caseof gastroenteritis.

•Drink plenty of clear fluids or over-the-counter rehydrationsolutions to preventdehydration.CONSULT YOUR DOCTORif you are no betterin 2 days or if othersymptoms develop.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may havegallstones, especially if you have sufferedfrom nausea andvomiting followinga fatty meal.

•Take an analgesicsuch as acetaminophento relieve symptoms.

•Avoid eating foodsthat are high in fat.

Severe

Mild ormoderate

How severe is the pain?

Danger signs

No danger signs

Are anydanger signs

present?

Diarrhea

No diarrhea

Do you havediarrhea?

ABDOMINAL PAIN (ADULTS) 121

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have cystitisor a urine infectionthat has spread to oneor both kidneys.

• For both conditions,take an analgesic suchas acetaminophen.

•Drink 1 pint(500 ml) of fluidevery hour for 4 hours.

•Drinking cranberryjuice may relieve theburning sensation.

ACTION

GO TO ANOTHER CHARTChest pain, p.134

ACTION

GO TO ANOTHER CHARTAbdominal pain(women), p.122

ACTION

CALL YOUR DOCTOR NOWYou may have kidneystones, especially if youhave been vomiting.

•Drink plenty offluids to flush thestones into the urine.

• Save any urine youpass, particularly ifyou pass a stone.

•Take acetaminophento relieve discomfort.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may havenonulcer dyspepsia (arecurrent and persistentform of indigestion) orgastroesophagealreflux, in which acidfrom the stomach isregurgitated into theesophagus.

•Eat small meals atregular intervals.

•Avoid eating shortlybefore going to bed.

•Reduce your intake ofalcohol, coffee, and tea.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour abdominal painfrom this chart.

Pain is relatedto eating

Pain comes onwhen lying orbending over

None of the above

Pain is relievedby antacids


apply?

Pain whenurinating

Neither

Urinating moreoften than

usual


Female

Male

Are youfemale or

male?

What kind ofpain haveyou been

experiencing?

Pain that startsin the back and

may move tothe groin

Pain in the center of the

upper abdomen

Pain in theupper right

abdomen thatmay spread to

the back

Pain mainlybelow the waist

None of the above

122

Abdominal pain (women)First refer to abdominal pain, p.120

Several disorders specific to women can causediscomfort or pain in the lower abdomen. Many ofthese conditions are related to the reproductive tract(ovaries, uterus, or fallopian tubes) or to pregnancy.Abdominal pain that occurs during pregnancyshould always be taken seriously.

!Abdominal painduring pregnancyIntermittent, mild abdominalpains are common throughoutpregnancy due to stretchingof the muscles and ligamentsof the abdomen. Abdominalpain that occurs in earlypregnancy can be due tocomplications, such asmiscarriage or an ectopicpregnancy. In later pregnancy,pain is most commonly causedby the onset of labor. Rarely,partial separation of theplacenta from the wall ofthe uterus may occur.

• If you develop severe pain,call your doctor at once.

FAMILY ILLNESS

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have cystitis.


•Drink 1 pint(500 ml) of fluid everyhour for 4 hours.


ACTION

CALL YOUR DOCTOR NOWYou could be having a late miscarriage orplacental abruption(separation of theplacenta from the wall of the uterus).

•Rest in bed until youreceive medical advice.

ACTION

CALL YOUR DOCTOR NOWPain at this stage mayindicate a threatenedmiscarriage or anectopic pregnancy.


More than 14weeks pregnant

Do not think so

Less than 14weeks pregnant

Are youpregnant?

Yes

No

START

Have youhad sexualintercoursein the past3 months?

Yes

No

Did your lastmenstrual periodoccur at the time

you expected?

On time

Missed or late

Do you havepain when you

urinate?

ABDOMINAL PAIN (WOMEN) 123

ACTION

CALL YOUR DOCTOR NOWThere is a possibilityof an ectopic pregnancy.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have pelvicinflammatory disease,in which there is aninfection in thereproductive organs.

•Your partner mayalso need to have testsfor infection.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour lower abdominalpain from this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORThis particular form ofcontraception can causeincreased menstrualpain, particularly forthe first few cyclesafter insertion.

ACTION

GO TO ANOTHER CHARTMenstrual pain, p.156

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORSome women regularlyhave pain associatedwith their ovulation.However, otherpossible causes doneed to be ruled out.

Abnormalvaginal

discharge

Neither of the above

Fever


Premenopausal

Postmenopausal

Have youpassed

menopause?

Is the painrelated to your

menstrualcycle?

Occurs justbefore and/or

during a period

Occurs briefly in midcycle

Unrelated

Do you have anintrauterine

contraceptivedevice (IUD)?

IUD

No IUD

Does your childhave severe

pain in eitherof the following

places?

Groin

Scrotum

Neither

124

Abdominal pain (children)For adults and children over 12, see p.120

Many children suffer from abdominal pain at sometime, and some children have recurrent episodes.Usually, the cause is not serious, and the painsubsides in a few hours without treatment. In rarecases, abdominal pain is a symptom of a seriousdisorder that requires prompt medical attention.

!Danger signsDial 911 or call an ambulanceif your child’s abdominal painis accompanied by any of thefollowing symptoms:

•Greenish yellow vomit.

•Pain in the groin or scrotum.

•Blood in the feces.

•Pain has been continuousfor more than 4 hours.

START

FAMILY ILLNESS

ACTION


a strangulated hernia ora testis that is twistedwithin the scrotum.


ACTION


a serious abdominalcondition, such asappendicitis.


ACTION

!DIAL 911 OR CALL EMSIf your child is under

5 years, he or she mayhave intussusception(a rare conditioncausing an intestinalobstruction). In olderchildren, the cause ofthese symptoms maybe food poisoning.


ACTION


an obstruction of theintestine.


Continuouspain for morethan 4 hours

Greenish yellowvomit

None ofthe above

Blood inthe feces


the following?

No diarrhea

Diarrhea

Does yourchild havediarrhea?

ABDOMINAL PAIN (CHILDREN) 125

ACTION

TRY SELF-HELP MEASURESYoung children oftenhave abdominal painin association with acold or flu.

•Give your childliquid acetaminophento relieve pain.

• Inhaling steam froma bowl of hot water(p.165) may help.

!DIAL 911 OR CALL EMSif your child

develops danger signs(see box opposite).

ACTION

CALL YOUR DOCTOR NOWif your child is under1 year. He or she mayhave gastroenteritis.

•Give older childrenplenty of clear fluidsto drink.CONSULT YOUR DOCTORif an older child is nobetter within 24 hoursor if other symptomsdevelop.

Has pain beenrelieved by


Vomiting

Passing gasor stools

Neither

Does yourchild have any of thefollowing?

Sore throat

Cough

Runny nose

None of the above

Does yourchild have any

of thefollowing?

Pain whenurinating

Temperature of 100.4°F (38°C)

or above

Renewedbedwettingor daytime“accidents”

None of the above

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child may have aurinary tract infection.

•Give your childplenty of clear fluidsto drink.

ACTION

SEE YOUR DOCTOR WITHIN 24 HOURSif you cannot identifya possible cause foryour child’s abdominalpain from this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORRecurrent abdominalpain in children cansometimes be relatedto anxiety.

Has your childsuffered from

similar bouts ofabdominal painover the pastfew weeks?

Previousabdominal pain

No previouspain

126 FAMILY ILLNESS

Swollen abdomenEnlargement of the abdomen is usually due toweight gain or poor muscle tone from lack ofexercise. A swollen abdomen may also result from adisorder of either the digestive system or the urinarysystem. If you have abdominal swelling that hascome on rapidly, you should consult your doctorirrespective of any other symptoms you may have.

Less than24 hours

Longer than 24 hours

How long hasyour abdomenbeen swollen?

START

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSThe swelling could bedue to an abnormallyfull bladder causedby a blockage at thebladder outlet.

ACTION

GO TO ANOTHER CHARTSwollen ankles, p.148

ACTION

TRY SELF-HELP MEASURESA swollen abdomenmay be the the firstsign of an unsuspectedpregnancy, especiallyif you have been usingcontraception or ifyour menstrual periodstend to be irregular.

• If you think thatyou might be pregnant,perform a homepregnancy test.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may be sufferingfrom excessive gas orconstipation, possiblydue to irritable bowelsyndrome.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identify apossible cause for yourabdominal swellingfrom this chart.

Severe pain

No pain

Mild pain

Do you haveabdominal

pain?

Your anklesare swollen

You havedifficultyurinating

You urinateonly smallvolumes

None ofthe above

You could bepregnant


apply?

Is the painrelieved by

passing gas orhaving a bowel

movement?

Relieved

Unrelieved

ACTION

GO TO ANOTHER CHARTAbdominal pain(adults), p.120, orAbdominal pain(children), p.124

Have you noticed

bleeding fromthe anus?

Bleeding

No bleeding

127SWOLLEN ABDOMEN • ANAL AND RECTAL PROBLEMS

Anal and rectal problemsThe anus is the opening of the lower large intestine(rectum) to the outside. Discomfort during bowelmovements may be due to a disorder of the rectum,the anus, or the skin around the anus. Rectal or analbleeding is often due to hemorrhoids but can also bean early symptom of cancer. Consult your doctor ifyou have any bleeding or persistent discomfort.

START

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have apilonidal sinus (smallpit at the top of thiscrease, which canresult in an abscess).

• Soak the affectedarea in warm water.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identify apossible cause for youranal or rectal problemfrom this chart.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORIt is possible that youhave genital warts.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTOR You may have apinworm infestation.

ACTIONTRY SELF-HELP MEASURESYou may havehemorrhoids, butitching can also occurfor no obvious reason.

•Try using an over-the-counter hemorrhoidpreparation to relievethe itching.CONSULT YOUR DOCTORif the itching continuesfor more than 3 days.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSAlthough hemorrhoidsare a likely cause,there is a slightpossibility of cancerof the colon, rectum,or anus that needs tobe excluded.

Pain in oraround the

anus or rectum

Neither

Sore area in thecrease above

the anus


White “threads”in your feces

Itching is worse in bed at night

Neither


Itching

No itching

Do you haveitching around

the anus?

Do you havesmall, irregular,

fleshy lumpsaround the anus?

Yes

No

128

Diarrhea (adults)For children under 12 years, see p.130Diarrhea is the frequent passing of abnormally looseor watery feces, and is usually a result of infection.However, persistent diarrhea may be caused by aserious gastrointestinal disorder. You should consultyour doctor if diarrhea continues for more than2 days or if it recurs.

FAMILY ILLNESS

!

Blood

No blood

Have younoticed blood in your feces?

START

ACTION

TRY SELF-HELP MEASURESYou may have foodpoisoning.

• Follow the advicefor preventingdehydration (p.165). CONSULT YOUR DOCTORif you are no better in2 days or if any othersymptoms develop.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou probably haveirritable bowelsyndrome, especiallyif you have sufferedabdominal pain andexcessive gas.However, the slightpossibility of cancer ofthe colon or rectumneeds to be excluded.

•Avoid large meals,spicy, fried, and fattyfoods, and milkproducts.

•Cut down on coffee,tea, soda, and beer.

Has the diarrheabeen alternating

with bouts ofconstipation?

Constipationand diarrhea

Diarrhea alone

Have you hadseveral boutsof diarrhea

over the pastfew weeks?

Yes

No

Have you recentlyconsumed foodor water that

may have beencontaminated?

Possible

Unlikely

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have anintestinal infection,such as amebiasis,or ulcerative colitis(ulceration of therectum and colon).However, the slightpossibility of cancer of the colon or rectumneeds to be excluded.

DehydrationA person with bad diarrheacan become dehydrated iffluids are not replaced quicklyenough. The symptoms ofdehydration include confusionor drowsiness, a dry mouth,loss of elasticity in the skin,and failure to urinate forseveral hours. Elderly peopleare particularly at risk. Followthe advice for preventingdehydration on p.165, butseek urgent medical help if aperson has severe symptoms.

DIARRHEA (ADULTS) 129

ACTION

TRY SELF-HELP MEASURESYou probably havegastroenteritis or foodpoisoning.

• Follow the advicefor preventingdehydration (p.165).CONSULT YOUR DOCTORif you are no better in2 days or if any othersymptoms develop.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have anintolerance of a specificfood or foods.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAnxiety disorders canbe a cause of diarrhea.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour diarrhea fromthis chart.

ACTION



ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have pickedup an intestinalinfection, such asgiardiasis, duringyour travels abroad.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have anintestinal disorder.

Nausea orvomiting

Neither


(38°C) or above


Do you haverecurrent painin the lowerabdomen?

No

Yes

Is your diarrheaassociated with


Eating particular foods

Period of stress

Neither

Medication

No medication


Have the attacksof diarrhea

occurred sincea visit abroad?

Foreign travel

No foreigntravel

130

Diarrhea (children)For adults and children over 12, see p.128

Diarrhea is the abnormally frequent passage of looseor watery feces. Breast-fed babies may pass loosefeces several times a day, and this is normal. If yourchild has diarrhea, he or she should drink plenty ofclear fluids to avoid dehydration. If symptoms donot improve, consult your doctor.

!Danger signsDial 911 or call EMS if yourchild also has any of the following symptoms:


•Severe abdominal pain orabdominal pain that lastsfor 4 hours or more.

•No urination during the dayfor 3 hours (if under 1 year)or 6 hours (in an olderchild).

•Refusal to drink or feed(in babies) for over 6 hours.

•Blood in the feces.

FAMILY ILLNESS

Less than 3 days

3 days or more

How long hasyour child had

diarrhea?START

Does yourchild have any

of thefollowing?

Abdominal pain

Temperature of100.4°F (38°C)

or above

Vomiting

None of the above

ACTION

CALL YOUR DOCTOR NOWif your child is under 6months. He or she mayhave gastroenteritis.CONSULT YOUR DOCTOR if your child is over 6months and not betterwithin 24 hours or ifany other symptomsdevelop.

• Follow the advicefor preventingdehydration (p.165).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORPersistent constipationcan lead to fecestrickling from the anus,which may be mistakenfor diarrhea.

Was your childconstipated

before the onsetof diarrhea?

Constipated

Not constipated

Is yourchild gainingweight and

growing at anormal rate(see growth

charts, p.71)?

Yes

No

Medication

No medication

Is your childcurrently takingany medication?

Uniformlyrunny

Contains piecesof food

What is theappearance of

the feces?

DIARRHEA (CHILDREN) 131

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour child’s symptomsmay be a side effect ofthe drug.

• Stop giving any over-the-counter medicinesbut continue to giveprescribed medication unless advised to stopby your doctor.

ACTION

TRY SELF-HELP MEASURESYoung children oftenfail to chew and digestfood properly, whichcan lead to so-called“toddler’s diarrhea.”

•Follow the advicefor preventingdehydration (p.165). CONSULT YOUR DOCTORif symptoms persist orif your child developsother symptoms.

ACTION

TRY SELF-HELP MEASURESPsychological stress orunusual excitementcan cause diarrhea inchildren. The symptomswill normally stop assoon as the cause hasdisappeared. CONSULT YOUR DOCTORif there is a long-termcause of anxiety inyour child’s life or ifhe or she developsother symptoms.

ACTION

TRY SELF-HELP MEASURESFoods that are new toyour baby may causedigestive upsets.

•Withhold the foodthat seems to becausing the troublefor at least 1 week. CONSULT YOUR DOCTORif your baby is nobetter in 24 hours orif he or she developsother symptoms.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORIt is possible that yourchild has a conditionaffecting the digestivetract, such as foodintolerance or celiacdisease (gluten allergy).

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour child’s diarrheafrom this chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSif you cannot identifya possible cause foryour child’s diarrheafrom this chart.

ACTION

TRY SELF-HELP MEASURESSugar in food anddrink can causediarrhea in babies.

•Avoid giving yourbaby sweetened foodsand drinks. CONSULT YOUR DOCTORif your baby is nobetter in 24 hours orif he or she developsother symptoms.

Under12 months

Over 3 years

12 months to 3 years


Is your childexperiencing

unusual stress,anxiety, or

excitement?

Stress oranxiety

Excitement

Neither

Was your babygiven any ofthe following

before the onsetof diarrhea?

Unfamiliarfoods

Sugary foodsor sweetened

drinks

Neither

132

ConstipationSome people have a bowel movement once or twicea day; others do so less frequently. If you have fewerbowel movements than usual or if your feces aresmall and hard, you are constipated. The cause isoften a lack of fluid or fiber-rich foods in the diet. If constipation occurs suddenly or persists despite a change in your diet, consult your doctor.

!Blood in the fecesBlood can appear in the fecesas red streaks or in largeramounts. It can also makethe stools look black. Smallamounts of blood in thefeces are usually caused byminor anal problems, such ashemorrhoids, but you shouldalways consult your doctor ifyou notice blood in the fecesbecause it is vital that othercauses, such as colorectalcancer, are excluded.

FAMILY ILLNESS

How longhave you

suffered fromconstipation?

For a fewweeks or less

For severalmonths or years

START

You regularlyignore the

urge todefecate


apply?

You regularlyuse stimulant

laxatives

Neither

ACTION

TRY SELF-HELP MEASURESYour constipation isprobably due to a lackof fiber or fluid inyour diet and possiblyto lack of exercise.

• Include more fiber-rich foods in your diet.

•Avoid eating toomuch processed food.

• Increase your dailyfluid intake.

•Do not ignore theurge to defecate.CONSULT YOUR DOCTORif your symptoms havenot improved within2 weeks.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORPain on defecation can cause or worsenconstipation. You mayhave hemorrhoids oran anal fissure (tear inthe lining of the anus).

ACTION

TRY SELF-HELP MEASURESYour bowel reflexesmay have becomesluggish as a result ofbeing ignored.


• Increase your dailyfluid intake.CONSULT YOUR DOCTORif your symptoms havenot improved within2 weeks.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORRegular use ofstimulant laxatives,such as senna, canseriously disrupt thenormal functioning of the bowels.

Do you havepain in your

rectum or anuswhen youdefecate?

Pain

No pain

Do you haveintermittent

bouts ofcramping painin the lowerabdomen?

Pain

No pain

CONSTIPATION 133

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORIrritable bowelsyndrome is a possiblecause, especially ifyour constipationalternates with boutsof diarrhea. However,other causes, such ascancer of the colon,rectum, or anus, mayneed to be ruled out.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORHypothyroidism(underactivity of thethyroid gland, whichcauses many bodyfunctions to slowdown) is a possibility.

ACTION



ACTION

TRY SELF-HELP MEASURESA change in yourregular diet, especiallywhen traveling, canmake you constipated.



• Increase your dailyfluid intake.

•Do not ignore theurge to defecate. CONSULT YOUR DOCTORif your symptoms havenot improved within2 weeks.

ACTION

TRY SELF-HELP MEASURESConstipation is quitecommon in pregnancy.



• Increase your dailyfluid intake, but avoidcaffeine and alcohol.

•Do not ignore theurge to defecate.CONSULT YOUR DOCTORif your symptoms havenot improved within2 weeks.

ACTION

TRY SELF-HELP MEASURESLack of fluid in thebowel as a result of aninadequate fluid intakeor excessive fluid losscan cause constipation.

•Drink plenty offluids, especially if theweather is hot. CONSULT YOUR DOCTORif your symptoms havenot improved within2 weeks.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour constipation fromthis chart.

Fatigue

Increased drynessor roughnessof the skin


Feeling the coldmore than you

used to

Unexplainedweight gain

General hairthinning

None ofthe above

You arepregnant

You have beendrinking less fluid

than usual


apply?

You have changedyour diet

None ofthe above

Medication

No medication


134

Chest painPain in the chest, or any discomfort felt in the frontor back of the ribcage, is most often due to minordisorders such as muscle strain or indigestion.However, you should dial 911 or call EMS if youhave a crushing pain in the center or left side of yourchest, if you are also short of breath or feel faint, orif the pain is unlike any pain you have had before.

FAMILY ILLNESS

Crushing

Spreading fromthe center of thechest to the neck,

arms, or jaw


What kind ofpain are you

experiencing?START

Short of breath

Not short of breath

Are you shortof breath?

Related tobreathing

Not related to breathing

Is pain relatedto breathing?

Previousepisodes of this

kind of pain

Never before

Have you hadthis painbefore?

Does the painsubside afteryou rest for afew minutes?

Pain subsides

Pain persists

ACTION

CALL YOUR DOCTOR NOWRecurrent chest paincould be an indicationof angina, especially ifpain in the chest occurswith exertion anddisappears with rest.

ACTION


blood clot in the lung.

ACTION

!DIAL 911 OR CALL EMSYou may be having a

heart attack.

•While waiting, chewhalf an aspirin, unlessyou are allergic to it.

ACTION

!DIAL 911 OR CALL EMSYou may be having a

heart attack.


You have recently had

surgery

You have recentlybeen immobiledue to injury

or illness


apply?

You have had ababy within the

past 2 weeks

None of the above

CHEST PAIN 135

ACTION

!DIAL 911 OR CALL EMSYou may be having

a heart attack.


ACTION

CALL YOUR DOCTOR NOWYou may have a chestinfection, such aspneumonia.

•Take an analgesicsuch as acetaminophento reduce fever andchest pain.

•Drink lots of fluid.

ACTION

TRY SELF-HELP MEASURESYou have probablystrained and/or bruiseda muscle.

•Take an analgesicsuch as acetaminophenand rest for 24 hours. CONSULT YOUR DOCTORif the pain has notimproved after this time.

ACTION

CALL YOUR DOCTOR NOWYou may have apartially collapsed lung.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have a lunginfection or pleurisy.

•Take an analgesicsuch as acetaminophento relieve pain and fever.

• If you have a fever,drink lots of fluid.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause for your chest pain fromthis chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haverecurrent indigestionor heartburn causedby acid reflux.

Does the painhave any of

the followingfeatures?

Related to eating or to

particular foods

Relieved byantacids

Brought onby bending or

lying down

None of the above



or above?

Fever

No fever

Sore to touch

Not soreto touch

Is the chestsore to touch?

You have had a chest injury

Neither

You have beenexercising


apply?

136 FAMILY ILLNESS

PalpitationsAbnormally fast or irregular heartbeats, orpalpitations, are often caused by anxiety or bystimulants, such as caffeine and nicotine.Palpitations may also occur as a side effect ofmedication or because of a heart disorder. Call yourdoctor immediately if palpitations are frequent orpersistent or if you have other symptoms.

Shortness ofbreath


None of the above

Chestdiscomfort


START

You have had alot of coffee, tea,

or soda

You have been smoking more

than usual

You are takingmedications

None of theabove


apply?

ACTION


serious arrhythmia(abnormal heartrate or rhythm) dueto an underlyingheart disorder.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may havehyperthyroidism (anoveractive thyroidgland) or you might besuffering from anxiety.

ACTIONTRY SELF-HELP MEASURESThese symptoms maybe due to anxiety.

•Try some relaxationexercises (p.169). CONSULT YOUR DOCTORif your symptomscontinue for 2 days.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour palpitations fromthis chart.

ACTION



ACTIONTRY SELF-HELP MEASURES

•Avoid caffeine andnicotine because thesecan disturb yourheart rhythm.CONSULT YOUR DOCTORif your symptomscontinue for 2 days.

Weight losswith increased

appetite

Increasedsweating

Bulging eyes

None of the above

Feeling on edge


Feeling understress

No increasein stress

Have you beenfeeling tenseor stressed?

137PALPITATIONS • POOR BLADDER CONTROL

Poor bladder controlIf urinating is painful, see p.138Inability to control urination may result in leakageof urine or difficulty urinating. These symptomsmay be due to a bladder, nerve, or muscle disorder.In men, an enlarged prostate gland is a commoncause. Urinary tract infections can also causeleakage of urine, especially in elderly people.

.!Inability to urinateInability to urinate, eventhough the bladder is full,is a serious symptom. Itmay be the result of anobstruction or damageto nerves that supply thebladder, or it may be aside effect of certain drugs.You should call yourdoctor immediately.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have anenlarged prostate gland,especially if you areover 55, or a narrowingof the urethra (tube thatempties the bladder).

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may be sufferingfrom an irritable bladder.

ACTIONTRY SELF-HELP MEASURESYou probably havestress incontinence.

•Try Kegel exercises:contract, hold, andrelax pelvic floormuscles 10 times,several times a dayto strengthen them. CONSULT YOUR DOCTORif the condition does notimprove in 1 month.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORSome drugs, particularlythose that act on urineproduction or on thenervous system, canaffect bladder control.


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour poor bladdercontrol from this chart.

Female

Male

Are youfemale or

male?START

Difficultystarting to

urinate

Neither

Weak urinarystream


Medication

No medication


A strong urge to urinate with

little urine passed

Neither

Leakage of urinewhen you cough,

sneeze, or run


138

Painful urinationPain or discomfort while urinating is usually causedby inflammation of the urinary tract, often due toinfection. Frequent painless urination can be due to diabetes or kidney problems and should beinvestigated by your doctor. Discolored urine canaccompany this type of pain but may not indicatedisease (see Checking the appearance of urine, right).

Checking theappearance of urineThe appearance of urine variesconsiderably. For example,urine is often darker in themorning than later in the day.Some drugs and foods mayalso cause a temporary colorchange in the urine. Beets,for example, may turn theurine red. A change in yoururine can indicate a disorder.Very dark urine may be asign of liver disease, such asacute hepatitis, while red orcloudy urine may be due tobleeding or an infectionin the kidney or bladder.

• If you are not sure aboutthe cause of a change in theappearance of your urine,consult your doctor.

FAMILY ILLNESS

Pain in the backjust abovethe waist

A temperatureof 100.4°F

(38°C) or above

Neither


START

Have you feltthe need to

urinate morefrequentlythan usual?

Increasedfrequency

No increasedfrequency

ACTION

CALL YOUR DOCTOR NOWYou may havepyelonephritis (infectionof the kidneys).


ACTION



•Drink 1 pint (500 ml)of fluid every hour for4 hours.


Lowerabdominal pain

Cloudy urine

None of the above

Blood in the urine


Female

Male

Are youfemale or

male?

PAINFUL URINATION 139

Do you havean unusual

discharge fromyour penis?

Discharge

No discharge

Have younoticed

soreness oritching in thegenital area?

Soreness

Itching

Neither

Do you havean unusual

vaginaldischarge?

Thick, whitedischarge

Yellowish greendischarge

No unusualdischarge

ACTION

TRY SELF-HELP MEASURESYou may have vaginalthrush.

• If you have hadthrush before, try usingan over-the-counterantifungal preparationrecommended byyour pharmacist. CONSULT YOUR DOCTORif this is the first timeyou have had thesesymptoms.

ACTION



•Drink 1pint (500 ml)of fluid every hour for4 hours.


ACTION

SEE YOUR DOCTORWITHIN 24 HOURSor go to a clinic thatspecializes in sexuallytransmitted diseases.You may have avaginal infection, suchas bacterial vaginosisor trichomoniasis, oran STD, such asgonorrhea.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour symptoms from this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour symptoms from this chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSor go to a clinic thatspecializes in sexuallytransmitted diseases.You may have an STD,such as gonorrhea ornongonococcalurethritis.

140

Back painMild back pain is usually caused by poor posture,sudden movement, or lifting heavy objects, all of which may strain the back. Back pain is alsocommon in pregnancy. Persistent or severe backpain may be the result of a more serious problem.You should consult your doctor if pain is severe or does not improve after 48 hours.

!Danger signsDial 911 or call EMS if youhave back pain that isassociated with one ofthe following symptoms:

•Difficulty controllingyour bladder.

•Difficulty controllingyour bowels.

•Sudden pain above waistwith shortness of breath.

•Difficulty moving.

FAMILY ILLNESS

Did the painin your back

come on aftereither of thefollowing?

An injury or fall

A sudden,awkward

movement

Neither

START

Difficultymoving a leg


Numbness ortingling in a leg

Have younoticed either ofthe following?

ACTION

CALL YOUR DOCTOR NOWYou may have pincheda nerve in your back ordamaged your spine.

ACTION

TRY SELF-HELP MEASURESYou have probablystrained a back muscleand/or bruised yourback by overstretchinga muscle.

•Rest and takeanalgesic such asacetaminophen.

• Place a covered hot-water bottle or heatpad against your backfor additional relief. CONSULT YOUR DOCTORif you are no betterwithin 24 hours.

ACTION

CALL YOUR DOCTOR NOWYou may havepyelonephritis (infectionof the kidneys).


Pain in the backjust above the

waist

Neither

A temperatureof 100.4°F

(38°C) or above


Lifting a heavy weight

Strenuous orunusual

physical activity

A coughing fit

Did the painoccur after any

of the following?

None of the above

BACK PAIN 141

ACTIONTRY SELF-HELP MEASURESYou have probablystrained some of themuscles or sprainedsome of the ligamentsin your back. •Take an analgesicsuch as acetaminophen.

• Place a covered hot-water bottle or a heatpad against your backto ease the pain.CONSULT YOUR DOCTORif you do not feel anybetter in 2 or 3 daysor if any othersymptoms develop.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may havefractured a vertebra asa result of osteoporosisor have sciatica, causedby a slipped disk.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haveankylosing spondylitis(a form of arthritisaffecting the back of thepelvis and the vertebraeof the spine), especiallyif you are male.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haveosteoarthritis.

ACTION

CALL YOUR DOCTOR NOWNew back pain or aworsening of existingback pain may indicatethe start of labor.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour back pain fromthis chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may havefractured a vertebra asa result of osteoporosis.

Have you beensuffering fromincreasing painand stiffnessfor severalmonths?

Yes

No

You are over 60

You have recentlybeen immobiledue to illness

or injury

Neither


apply?

Pain makes anymovement

difficult

Neither

Pain shootsfrom the spinedown the back

of the leg


apply?

45 or over

Under 45

How old are you?

Pregnant

Not pregnant

Are you in thelast 3 monthsof pregnancy?

142

Neck pain or stiffnessPain and/or stiffness in the neck is usually due toa minor problem that does not require treatment,such as a muscle strain or a ligament sprain.However, if the pain occurs with fever, meningitis isa possibility. Neck pain or stiffness becomes morecommon as people grow older; and may then be due to a disorder of the neck bones and joints.

!Danger signsDial 911 or call EMS if youhave neck pain associatedwith any of the following:

•Difficulty controlling your bladder.

•Difficulty controlling your bowels.

•Severe headache.



FAMILY ILLNESS

How long haveyou had pain

and/or stiffnessin the neck?

Less than24 hours

24 hours or longer

Pain, numbness, or tingling in an

arm or leg

Loss of bladdercontrol

None of the above

Difficulty moving an arm or leg


ACTION

TRY SELF-HELP MEASURESYour neck is probablystrained and/or bruisedfrom overstretchinga muscle.

•Take an analgesicsuch as acetaminophenand rest lying down.

•A heat pad orcovered hot-waterbottle placed againstyour neck may provideadditional pain relief. CONSULT YOUR DOCTORif you are no better in24 hours.

ACTION


damaged your spine.

• Follow the first-aidadvice for spinalinjuries (p.46).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haveosteoarthritis of theupper spine, especiallyif you are over theage of 45.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour neck pain orstiffness from this chart.

Pain and stiffnessworsening overmany months

Neck pain withnumbness or painin the arm/hand

Which of thefollowing

describes yoursymptoms?

Neither

Have youjolted or injuredyour neck, for

example in a caraccident or fall?

Neck injury

No neck injury

START

NECK PAIN OR STIFFNESS 143

ACTION


meningitis (infectioninflaming membranesaround the brain).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour neck pain orstiffness from this chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYour neck pain maybe due to pressureon a nerve as a resultof a slipped disk orosteoarthritis of theupper spine.

ACTION

TRY SELF-HELP MEASURESYou may have strainedyour neck over-stretching a muscle.

•Rest your neck asmuch as possible bylying down.

•Take a nonsteroidalanti-inflammatory drug,such as ibuprofen, toease the pain.

•Keeping your neckwarm with a heatingpad or covered hot-water bottle may help. CONSULT YOUR DOCTORif you are no better in3 days.

ACTION

GO TO ANOTHER CHARTLumps and swellings,p.80


(38°C) or above



Nausea orvomiting

None of the above

Severeheadache


Pain is severeenough to

preventmovement

Neither

Pain shoots down one arm from the neck


apply?

Can you feel anytenderness or

swelling at thesides or the back

of the neck?

Yes

No

You exercisedunusually

strenuously

Neither

You sat or sleptin an awkward

position

Did either of thefollowing applyin the 24 hours

before the onsetof pain?

144 FAMILY ILLNESS

Arm or hand painIf you have joint pain, see p.146Pain in the arm or hand is often caused by injuryor a problem in the neck or shoulder. Rarely, painin the arm is due to a heart attack or a seriousneck disorder. Consult your doctor if the pain issevere, recurrent, or persistent.

ACTIONCALL YOUR DOCTOR NOWif you are in severepain. You may haveeither fractured a boneor damaged a muscle.

• Follow the first-aidadvice for a brokenarm (p.44).TRY SELF-HELP MEASURESif not in severe pain.

• Follow the first-aidadvice for sprains andstrains (p.47).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have repetitivestrain injury.


ACTION

!DIAL 911 OR CALL EMSYou may be having

a heart attack.


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haveinflammation of atendon or polymyalgia,in which musclesbecome inflamed,particularly if you areover 60 years old.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have a pinchednerve in your neck.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR if you cannot identifya possible cause foryour arm or hand painfrom this chart.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have acompressed nerve inthe wrist (carpaltunnel syndrome).

Did the painstart during

or soon aftereither of thefollowing?

An injury or fall

Repetitive arm or handmovements

Neither

Is the painassociated

with any ofthe following?

Chest tightness

Shortness of breath

Nausea, sweating,or feeling faint

None of the above

START

Localized in upperarms or shoulders

What are the features of the pain?

Shoots downthe length of

the arm

None of the above

Extends fromthe wrist intothe palm and

lower arm

145ARM OR HAND PAIN• LEG PAIN

Leg painIf you have joint pain, see p.146Leg pain due to a strained muscle or torn ligamentusually goes away without treatment. Pain mayalso result from a problem in the lower back orin the blood vessels in the leg. If your leg is alsoswollen, hot, or red, see your doctor at once.

ACTIONCALL YOUR DOCTOR NOWif you are in severepain. You may haveeither fractured a boneor damaged a muscle.

• Follow the first-aidadvice for a brokenleg (p.45).TRY SELF-HELP MEASURESif not in severe pain.


ACTION

CALL YOUR DOCTOR NOWYou may have deepvein thrombosis(blood clot in a veinin your leg).

ACTIONTRY SELF-HELP MEASURESYou may have straineda muscle.


ACTIONSEE YOUR DOCTORWITHIN 24 HOURSYour symptoms maybe caused by cellulitis(infection of the skinand underlyingtissue) or superficialthrombophlebitis(inflamed surface vein).

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour leg pain from thischart.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have sciatica.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have a musclecramp, but, if the painoccurs with exerciseand disappears withrest, you may haveclaudication due tonarrowing of the bloodvessels in the leg.

ACTIONMAKE AN APPOINTMENTTO SEE YOUR DOCTORVaricose veins are apossible cause.

Did the painstart during or

soon aftereither of thefollowing?

An injury or fall

Unusualexercise

Neither

START

Does sittingdown with yourfeet up relieve

the pain?

Yes

No

Affects a small area that is also

red and hot

Sudden tighteningof calf muscles

What are thefeatures of the pain?

Constant pain inthe calf, whichmay be swollen

Shooting pain down the back

of the leg

Heavy, aching legs

None of the above

Injury

No injury

Have youinjured

the joint?

Considerablyworsens it

Slightly worsensit or no change

Does movingthe joint affect

the pain?

146

Joint painIf your ankle is swollen painlessly, see p.148Pain in a joint may be caused by injury or strainand often disappears without a cause being found.Gout or a joint infection can cause a joint tobecome red, hot, and swollen. Joint pain may alsobe a reaction to an infection or due to arthritis.Consult your doctor if pain is severe or persistent.

START

FAMILY ILLNESS

Hot joint(s)

Neither

Red joint(s)


One joint

More than one

How manyjoints areaffected?

ACTION

CALL YOUR DOCTOR NOWYou may have fractureda bone, strained ortorn a muscle, or torna ligament.

• Follow the first-aidadvice for a broken armor leg (pp.44–45).

ACTION

CALL YOUR DOCTOR NOWYou may have septicarthritis (infected joint)or gout.

•Rest the painful joint.

•Take ibuprofen at therecommended intervals.

•Drink lots of fluid.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may haveosteoarthritis.


• Put a covered hot-water bottle or heatingpad on the joint.

ACTION

TRY SELF-HELP MEASURESYou have probablystrained a ligamentaround the joint.

• Follow the first-aidadvice for sprains andstrains (p.47). CONSULT YOUR DOCTORif the joint is no betterin 24 hours.

Did the paincome on

gradually overmonths or years?

Yes

No

You cannotmove the joint

The joint appearsmisshapen or

swollen

Neither


apply?

JOINT PAIN 147

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may haverheumatoid arthritis.

•Take an analgesicsuch as ibuprofen.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURS Certain bacterialinfections of theintestines and genitaltract can lead toreactive arthritis (short-term inflammationof the joint).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have a frozenshoulder.

•Take an analgesicsuch as acetaminophento ease the pain.

•Rest your shoulder.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSMost childhood hipproblems are notserious, but some needprompt treatment toprevent lasting damageto the joint.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour joint pain fromthis chart.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSSome viral illnesses,such as rubella(German measles),can cause joint pain,but if you have beenbitten by a tick, aninfection such as Lymedisease could be thecause of the pain.

ACTION

TRY SELF-HELP MEASURESYour symptoms areprobably a result ofoveruse, althoughrecent viral illness mayalso be the cause.

•Rest the painfuljoint(s).

•Take an analgesicsuch as acetaminophento ease the pain.CONSULT YOUR DOCTORif your condition is nobetter in 2 days.

An infectionwith a rash

Neither

An infectionwithout a rash

Have yourecently hadeither of thefollowing?

Shoulder

Neck

Other joint(s)

Hip

Which joint or joints are

affected?

ACTION

GO TO ANOTHER CHARTNeck pain or stiffness,p.142

Under 12

12 or over

Is the problemin a childunder 12?

148

Swollen anklesIf you have a painful swollen ankle, see p.146

Slight, painless swelling of the ankles is most oftencaused by fluid accumulating in the tissues after longperiods of sitting or standing still, but it may be dueto heart, liver, or kidney disorders. Ankle swelling iscommon during pregnancy. If swelling persists or ifyou have other symptoms, consult your doctor.

FAMILY ILLNESS

Both ankles

One ankle

Are bothankles

affected?

ACTION

CALL YOUR DOCTOR NOWYou may have deep veinthrombosis (blood clotin a vein in your leg).

ACTION

TRY SELF-HELP MEASURESSwelling can persist orrecur for several weeksfollowing an injury.

• If the injury occurredwithin the past 2 days,follow the first-aidadvice for sprains andstrains (p.47).

• For a less recentlysustained injury, tryresting the limb for48 hours. CONSULT YOUR DOCTORif swelling persistsdespite rest or if theankle is painful,tender, or inflamed.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may be sufferingfrom heart failure, inwhich fluid accumulatesaround the body. Otherpossible causes are aliver or kidney problem.

Have you injuredyour ankle

within the pastfew weeks?

Recent injury

No recent injury

Is the calf ofthe affectedleg either of

the following?

Swollen

Tender

Neither

Pregnant

Not pregnant

Are youpregnant?

Have you beensuffering from

increasedshortness of

breath?

Shortness of breath

No shortness of breath

START

SWOLLEN ANKLES 149

Medication

No medication


ACTION

CALL YOUR DOCTORNOW Retainingexcessive amounts of fluid may be asymptom of pre-eclampsia, which, ifsevere, can be serious.

ACTION

TRY SELF-HELP MEASURESYou may have varicoseveins, which can causefluid to accumulate inthe ankles.

•Avoid standing stillfor long periods.

•Walk as much aspossible.

•When sitting down,try to keep your feetraised above hip level.

•Wear support hose.CONSULT YOUR DOCTORif the swelling worsensor if other symptomsdevelop.

ACTION

TRY SELF-HELP MEASURESSwollen ankles arecommon duringpregnancy, particularlyin the last 3 months.

•Avoid standing stillfor long periods.

• Put your feet upwhenever possible. CONSULT YOUR DOCTORif your face and/orfingers become swollenor if you start to puton weight rapidly.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYour symptom may bea side effect of the drug.


ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour swollen anklesfrom this chart.

ACTION

TRY SELF-HELP MEASURESHours of inactivity willlead to accumulation offluid in the ankles andincreases the risk ofdeveloping a blood clot.

•Clear excess fluid bytaking a brisk walk.

•Avoid sitting orstanding still forlong periods.

•When seated, keepyour legs raised.

Your face orfingers are

swollen

Neither

You have gained over 5 lb (2.3 kg)in the past week


apply?

Did your anklesbecome swollenduring either ofthe following?

A long train,car, or bus trip

Airplane flight

Neither

Do you haveprominent

veins in one orboth legs

affected byswelling?

Prominent veins

No prominentveins

150 FAMILY ILLNESS

Erectile dysfunctionOccasional incidences of erectile dysfunction, orfailure to have or maintain an erection, are not thatuncommon. Difficulties are usually caused by factorssuch as stress, fatigue, anxiety, or alcohol. Physicalcauses are not common. If erectile dysfunctionoccurs frequently, consult your doctor for advice.Safe and effective treatments are available.

!Nonmedical adviceTreatment from anonmedical source couldresult in the incorrectdiagnosis being madeor the wrong treatmentgiven. It is important thatyou consult a doctor, whocan rule out any medicalcause of your erectionproblems, before havingany form of treatment.

Sometimes

Never

Do you wakeup with anerection?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORLack of interest insex is likely to reduceyour ability to achievean erection.

ACTIONCONSULT YOUR DOCTORif you are concernedabout any problemswith your sexualperformance. Mostmen have occasionalerection problems,most likely due toanxiety – for exampleat the beginning of anew sexual relationship– or due to factors suchas fatigue or drinkingtoo much alcohol.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORCertain illnesses, suchas diabetes, can leadto erectile problems.Some drugs, includingthose prescribed forhigh blood pressureand antidepressants,can also have an effecton sexual performance.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour erection problemfrom this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAnxiety about yoursexual performanceis the most likelyexplanation for yourproblem. A physicalcause is unlikely.

How often doyou fail toachieve or

maintain anerection?

Onlyoccasionally

Frequently

Are you currentlyreceiving

treatment for an illness?

Treatment

No treatment

Yes

No

Are youinterested

in sex?START

151ERECTILE DYSFUNCTION• TESTES AND SCROTUM PROBLEMS

Testes/scrotum problemsCheck regularly for lumps or swellings in the testes,the sperm-producing organs, and the scrotum, thesac containing the testes (see Testes: self-examination,p.69). The cause may be minor, but there is apossibility of cancer of the testis, which is easilytreated if diagnosed early. Painful swelling in thegenital area requires immediate medical attention.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR You probably have acyst in the epididymis(sperm-carrying tube inthe scrotum). However,the slight possibilityof cancer of the testisneeds to be ruled out.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have one ofthe following disordersof the scrotum: anaccumulation of fluid,a hernia, or varicoseveins. However, theslight possibility ofcancer of the testisneeds to be ruled out.

ACTION


torsion, or twisting,of the testis, especiallyif the pain is severe,which can result inpermanent damage ifnot treated promptly.A less serious possiblecause is inflammationof the epididymis(sperm-carrying tube),especially if you alsohave a fever.

ACTION

CALL YOUR DOCTOR NOWInternal damage to thetestes is a possibility.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have aninfection of the testesor epididymides(sperm-carrying tubes).The cause could be aviral infection, such asmumps, or a sexuallytransmitted disease.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour testes or scrotumproblem from this chart.

Pain andswelling

Generalizedpainless

swelling ofthe scrotum

None ofthe above

Painlessenlargement inor near testis

What is thenature of your

symptoms?START

One

Both

Does the problemaffect one or both testes?

Have you hadan injury in the

genital areawithin the past

48 hours?

Injury

No injury

Painful orsore penis

Foreskinproblem

Change inappearance of

erect penis

None ofthe above

Dischargefrom penis

What is theproblem?

152

Penis problemsIf you have erectile dysfunction, see p.150

Pain or soreness of the penis that is not related toinjury is often due to infection in the urinary tractor skin of the penis. Inflammation may be causedby friction during sexual intercourse. You shouldconsult your doctor if there is any change in theappearance of the skin of the penis.

Blood in the semenBlood-streaked semen isusually caused by leakagefrom small blood vessels inthe testes or epididymis. Asingle episode is unlikely tobe a cause for concern, but,if it recurs, you shouldconsult your doctor. It is alsoimportant to consult yourdoctor if you notice a blood-stained discharge that is notrelated to ejaculation or if younotice blood in your urine.START

FAMILY ILLNESS

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSor go to a clinic forsexually transmitteddiseases. You mayhave an STD infectionsuch as gonorrhea.

ACTION

!DIAL 911 OR CALL EMSInability to replace

a retracted foreskin(paraphimosis) canrestrict the blood flow.

•While waiting, placean ice pack against theaffected area.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may havePeyronie’s disease,which causes curvatureof the erect penis.

ACTION

GO TO ANOTHER CHARTPainful urination, p.138

Only withan erection

At other times

Only whenurinating

When does thepain occur?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAn abnormally tightforeskin may causethese problems.

After retraction,cannot be replaced

After childhood,cannot be fully

retracted

How is theforeskin

affected?

Balloons whenurinating

None of the above

PENIS PROBLEMS 153

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAn abnormally tightforeskin may causethis problem.

ACTION

CALL YOUR DOCTOR NOWYou may have anobstruction to the flowof blood leaving thepenis, which causesprolonged painfulerections and candamage the penis.

Subsided

Still present

Has the painfulerection now

subsided?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have balan-titis, which causes thehead of the head of thepenis to become itchy,sore and inflamed.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORor go to a clinic forsexually transmitteddiseases. This may bea chancre caused bysyphilis, or it could becancer of the penis.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORor go to a clinic forsexually transmitteddiseases. You mayhave genital warts.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have anallergic reaction to thelatex in condoms or toa contraceptive cream.

•Keep the skin moistwith an emollient creamsuch as petroleum jelly.

•Use a mild soap.

•Topical corticosteroidcreams may help toreduce inflammation.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR if you cannot identifya possible cause foryour problem fromthis chart.

Only tipinflamed

Neither

Whole penisinflamed

Has your penisbecome

inflamed?

Have younoticed either ofthe following on

your penis?

Flat, painlesssore

Small, fleshylumps

Neither

Do you have anyof the following

on the skin ofyour penis?

Ulcers

Sore areas

Blisters

None ofthe above

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORor go to a clinic forsexually transmitteddiseases. Any of theseskin symptoms may bethe result of an STD,such as genital herpes.

154

Breast problemsIt is important to familiarize yourself with thenormal look and feel of your breasts so that youare able to detect any changes in them (see Breasts:self-examination, p.69). Most breast problems arenot serious, but consult your doctor if you notice anychanges. Minor conditions clearly related to breast-feeding usually respond well to simple treatments.

FAMILY ILLNESS

Breastfeeding

Notbreastfeeding

Are youbreastfeeding

a baby?START

In the breast

On the nipple

Where is theproblem?

Tender onlywhen feeding

Tender and painful all the time

How isyour nippleaffected?

Single lump inthe breast

Discharge fromthe nipple

Breasts feeltender

Breasts feellumpy and hard

None ofthe above

A nipple haschanged inappearance


breast problem?

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORDischarge from thenipple may be causedby a local infection ora hormonal problem.However, the possibilityof breast cancer needsto be ruled out.

ACTION

MAKE AN APPOINTMENT

TO SEE YOUR DOCTOR

if you cannot identifya possible cause foryour breast problemfrom this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour breast problemfrom this chart.ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORThese symptoms maybe caused by minorproblems that are easilytreatable or that needno treatment. However,such changes must beinvestigated promptlyto rule out the chanceof breast cancer.

Small, hardlump in breast

Redness of part orall of one breast

None ofthe above

Swollen, hard, andtender breasts


symptoms?

BREAST PROBLEMS 155

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTOR if the lump has notdisappeared within aweek or if the breastbecomes painful or red.The lump may becaused by a blockedmilk duct.

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou may have mastitis(a breast infectioncausing inflammation)or even a breast abscess,particularly if you arealso not feeling well.

•Continue tobreastfeed from bothof your breasts.

ACTION

TRY SELF-HELP MEASURESOverfull breasts arecommon, especiallywhen you first startbreastfeeding and yourmilk supply has notyet adjusted to yourbaby’s needs.

•Continue tobreastfeed your babyat regular intervals.


• Place a heating pador covered hot-waterbottle on the affectedbreast(s).CONSULT YOUR DOCTORor breastfeedingadviser if you areconcerned.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are concerned.The problem maysimply be the resultof hormonal changesassociated with themenstrual cycle that canlead to premenstrualbreast tenderness.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORBreast tenderness iscommon duringpregnancy. If you arenot sure whether youare pregnant, performa home pregnancy test.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour breast problemfrom this chart.

ACTION

TRY SELF-HELP MEASURESThis problem may be aresult of your baby notlatching on to yournipple properly.

•Make sure that yourbaby takes the nippleand the surroundingarea into his or hermouth properly. CONSULT YOUR DOCTORor breastfeedingadviser if you are stillhaving problems whenyou use the correctfeeding technique.

ACTION

TRY SELF-HELP MEASURESYour symptoms maybe due to crackednipples, usually causedby your baby notlatching on properly.

•Keep your nipplesdry between feedingsand use moisturizingcream. CONSULT YOUR DOCTORor breastfeedingadviser if the problempersists or makesbreastfeeding difficult.

You are due tomenstruate

within 10 days

Neither

You mightbe pregnant


apply?

Are yourmenstrual

periods morepainful than

usual?

No worsethan usual

Worse than usual

Have you had anunusual vaginal

dischargebetween periods?

No discharge

Discharge

Do you havean intrauterinecontraceptivedevice (IUD)?

IUD

No IUD

Have yourmenstrual periodsbecome heavier

or longer?

Heavier

Longer

Neither

156 FAMILY ILLNESS

Menstrual period painMany women experience mild cramping pain in thelower abdomen during menstruation. This pain isconsidered normal unless it interferes with everydayactivities; it can usually be relieved by an analgesic.If you regularly have severe pain or if your periodsbecome unusually painful, consult your doctor torule out the possibility of infection or disorder.

START

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSYou could have pelvicinflammatory disease,which causes infectionin the reproductiveorgans.

ACTION

TRY SELF-HELP MEASURESSome pain experiencedduring your menstrualperiod is quite normal.

•Take an analgesicsuch as ibuprofen. MAKE AN APPOINTMENTTO SEE YOUR DOCTORif pain interferes withnormal activities.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORAn increase inmenstrual pain is a sideeffect of some IUDs.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have fibroids(noncancerous tumorsin the uterus) orendometriosis. This isa condition in whichthe tissue that usuallylines the uterusbecomes attached toother organs in theabdomen and bleedsduring menstruation.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour menstrual painfrom this chart.

Lower abdominalpain between

menstrual periods

Fever

None ofthe above

Lower back painbetween periods


Are yourmenstrual

periods morepainful than

usual?

More painful

The same orless painful

Are yourmenstrual

periods heavieror longer than

usual?

About the same

Heavier or longer

Do you havean intrauterinecontraceptivedevice (IUD)?

IUD

No IUD

Have you had asingle heavy

menstrual periodthat was later

than usual?

Yes

No

157MENSTRUAL PERIOD PAIN• HEAVY MENSTRUAL PERIODS

Heavy menstrual periodsIf you bleed between periods, see p.158Some women lose more blood than others duringtheir menstrual periods. If normal sanitary protectionis not sufficient, if bleeding lasts longer than 5 days,or if you notice that you are passing blood clots, thebleeding is probably excessive. If you are concernedabout heavy menstrual periods, consult your doctor.

START

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORSome women regularlyhave heavy menstrualperiods, sometimesaccompanied by painin the lower abdomen.However, the loss ofsignificant quantitiesof iron through heavybleeding could makeyou susceptible to iron-deficiency anemia.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORSome IUDs can causemenstrual periods to beheavier than normal.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause for your heavy menstrualperiods from this chart.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORHeavy, painful periodsmay be an indicationthat you have fibroids(noncancerous tumorsin the uterus) orendometriosis, whichcauses the tissue thatusually lines the uterusto become attached toother organs in theabdomen and bleedduring menstruation.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are concernedabout the cause ofyour late period. Lateperiods may be heavierthan usual. However, ifyou are sexually activethere is a possibilitythat you have had anearly miscarriage.

158

Abnormal vaginal bleedingVaginal bleeding is considered abnormal if it occursoutside the normal menstrual cycle, during pregnancy,or after menopause. Although there is often a simpleexplanation, you should always see your doctor ifyou have any abnormal vaginal bleeding. If you are pregnant and you notice bleeding, you shouldconsult your doctor immediately.

!Bleeding inpregnancyIf you have any vaginalbleeding during pregnancy,you should contact yourdoctor immediately. If thebleeding is heavy, dial 911 or call EMS. Although somecauses of bleeding are notserious, it is important to ruleout miscarriage or problemssuch as a low-lying placentaor partial separation of theplacenta from the wall of the uterus.

FAMILY ILLNESS

More than 14weeks pregnant

Not pregnant

Less than 14weeks pregnant

Are youpregnant?

Do you haveunusual painin the lower

back orabdomen?

Lower back pain

Abdominal pain

Neither

STARTACTION

CALL YOUR DOCTORIMMEDIATELYBleeding at this stageof pregnancy could bedue to a problem withthe placenta (see boxabove right).


ACTION

CALL YOUR DOCTORIMMEDIATELYYou may be having amiscarriage or youcould have an ectopicpregnancy.


ACTION

CALL YOUR DOCTORIMMEDIATELYBleeding at this stageof pregnancy could bethe first sign of athreatened miscarriage.


Is the bleedingsimilar tothat of a

normal period?

Like a period

Different

How longhas it been

since your lastmenstrual

period?

Less than6 months

More than6 months

ABNORMAL VAGINAL BLEEDING 159

You have onlyrecently started having periods

Neither

You are over 40


apply?

!HormonalcontraceptivesIn the first few menstrualcycles after startinghormonal contraceptionor changing to a differenttype of oral contraception,spotting is fairly common.If abnormal bleedingpersists or develops whenyou have had no previousproblems, you shouldconsult your doctor. He orshe may examine you andchange the dosage or typeof hormonal contraceptive.

Had sex

Not had sex

Have you noticedbleeding within

a few hoursof having sex?

Bleeding afterhaving sex

Bleedingunrelated tohaving sex

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORBleeding aftermenopause may bedue to a minor problemaffecting the vagina orcervix, such as cervicalerosion (in which thecervix becomes coveredwith delicate tissue,which has a tendencyto bleed). However, thepossibility of cancerof the uterus needsto be ruled out.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are concerned.Your menstrual periodsmay become irregularas you approachmenopause.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are concerned.Irregular periods arefairly common in thefirst year or so ofmenstruation.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are concernedor if your pattern doesnot return to normalwithin three menstrualcycles. Having anoccasional irregularperiod is unlikely toindicate a seriousproblem if the periodwas normal in allother respects.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have acervical abnormality,such as cervicalerosion (which causesfragile tissue that has atendency to bleed toform on the surface ofthe cervix), thedevelopment ofprecancerous cells, orcancer of the cervix.

ACTION

CALL YOUR DOCTOR NOWBleeding, especially ifaccompanied by painin the lower abdomen,may be the first sign ofan ectopic pregnancyor of an impendingmiscarriage, even ifyou were not awareof being pregnant.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour abnormal bleedingfrom this chart.

Have you had sex in thepast 3 months?

160 FAMILY ILLNESS

Vaginal dischargeIf the discharge contains blood, see p.158

A thin, clear or whitish discharge from the vaginais normal. This discharge will vary in consistencyand quantity with the stage of the menstrual cycle,during sexual arousal, and during pregnancy. Anabnormal discharge is usually caused by infectionand should be investigated by your doctor.

Thick and white

Normalappearance but

heavier than usual

Greenish yellow

What are thecharacteristics ofyour discharge?

None ofthe above

ACTION SEE YOUR DOCTORWITHIN 24 HOURSYou could have pelvicinflammatory disease(an infection of thereproductive organs).

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you cannot identifya possible cause foryour discharge fromthis chart.

ACTION TRY SELF-HELP MEASURESYou may have thrush,particularly if you alsohave genital irritation.

• If you have had thesesymptoms before, tryan over-the-counterproduct recommendedby a pharmacist. CONSULT YOUR DOCTORif this is the first timeyou have had thesesymptoms.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORor go to a clinic thatspecializes in sexuallytransmitted diseases.You may have avaginal infection suchas bacterial vaginosis.

ACTION

CONSULT YOUR DOCTORif you are concernedor if you developgenital irritation. Theseforms of contraceptionsometimes cause anincrease in normalvaginal secretions.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORif you are concerned orif you develop genitalirritation. Increasedvaginal secretion isnormal in pregnancy.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORCervical erosion, whichcauses fragile tissue toform on the surface ofthe cervix, may be thecause of your discharge.

Fever

Neither

Lowerabdominal pain


You are takingoral contraceptives

You arepregnant

None ofthe above

You havean IUD


apply?

START

161VAGINAL DISCHARGE • GENITAL IRRITATION (WOMEN)

Genital irritation (women)Itching and/or soreness in the genital area aresymptoms of genital irritation, which is oftencaused by chemicals in toiletries or detergents.Avoid these products and the irritation shouldclear up. Genital irritation may also be due toinfection, but often there is no obvious cause. Ifthe irritation is persistent, consult your doctor.

Have younoticed an

unusual vaginaldischarge?

Unusualdischarge

No unusualdischarge

START

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have a skincondition, such aseczema, that affectsthe genital area.

ACTION

TRY SELF-HELP MEASURES

You may be sensitiveto an ingredient in thenew product.

•Discontinue use ofthe new product.

• Use only water towash your genital area. CONSULT YOUR DOCTORif the irritation has notcleared up in 3–4 days.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORA change in yourhormone levels due tomenopause may bethe cause of irritation.

ACTION

MAKE AN APPOINTMENTTO SEE YOUR DOCTORYou may have pubiclice or irritation causedby an infection orallergic reaction.

Have you beenusing a new

toiletry item ornew laundrydetergent?

Yes

No

Your periodsare irregular orhave stopped

Neither

You are over 45


apply?

Have youbeen urinating

more thanusual?

Urinating more

No increase

ACTION

SEE YOUR DOCTORWITHIN 24 HOURSThese symptoms maybe due to diabetes.

ACTION

GO TO ANOTHER CHARTVaginal discharge(p.160)

Have you noticedany change in

the appearanceof the skin in the

genital area?

Skin changes

No skin changes

CONVENTIONAL MEDICINES

162 FAMILY ILLNESS

Home medicine chestIt is a good idea to keep a small supply of instruments and medicines at home for everyday aches and pains and first-aid emergencies. Many people now takecomplementary remedies as well as traditional medicines; recommendations forboth are given here. All supplies should be kept in their original containers with themanufacturer’s instructions and stored in a locked cabinet out of children’s reach.

AURAL THERMOMETERThese are used in the ear andare ideal for young children

ANTACID MEDICATIONLiquid or tablet antacids canhelp relieve the symptoms of

indigestion and heartburn

LAXATIVEPills help

relieve constipation

ALLERGY MEDICATIONAntihistamines help control

hay fever, allergicconjunctivitis, and bites

SUNSCREENCreams and oils protectskin from sun damage

1% HYDROCORTISONECREAM

Use this cream to sootheitchy or inflamed skin

COUGH REMEDIESUse cough mixtures orlozenges to soothe dry

or chesty coughs

MOTION SICKNESS PILLSTaking these pills prior to

travel can help preventmotion sickness

ORALREHYDRATION

DRINKThis fruit-flavoured

drink preventsdehydration

DIGITAL THERMOMETERUse this type of thermometerfor taking a temperature by

mouth or armpit

PAIN RELIEF FOR ADULTSAcetaminophen, aspirin, and

ibuprofen give relief frompain and inflammation PAIN RELIEF FOR CHILDREN

Liquid acetaminophen or liquidibuprofen provide relief frompain, fever, and inflammation

ORAL SYRINGEA syringe or dropper is

convenient for giving liquidmedicines to young children

COLD REMEDIESDecongestants and lozenges can

relieve cold symptoms

COMPLEMENTARY REMEDIES

163HOME MEDICINE CHEST

• Take homeopathic pilules no lessthan 30 minutes before or after food,and avoid drinking coffee and eatingstrongly flavored foods during acourse of medication.

• Ensure that only the person takingthe homeopathic remedy touches it;otherwise, it may lose its potency.

• Keep the remedies away from anyother medications and strong smells.

USING CONVENTIONAL MEDICINES

• Never give your own prescribedmedicines to another person, evenif you think that his or hersymptoms are similar to yours.

• Do not use any medicine that is pastits sell-by date or that shows signs ofdeterioration. Dispose of out-of-datemedicine by flushing it down the toiletor returning it to the pharmacist.

• Complete the whole course of anyprescribed medication, even if yoursymptoms have disappeared.

USING COMPLEMENTARY REMEDIES

ALLIUMThis is a standard

homeopathicremedy for hay

fever

NUX VOMICAThis homeopathic

remedy treatsindigestion andupset stomachs

GRAPHITESThis homeopathicremedy is used to

relieve eczemaand dermatitis

ARNICA CREAMThis homeopathicremedy aids the

healing of bruisesand sprains

CHAMOMILEThis homeopathic remedy

soothes teething painsand treats stress, nausea,

and vomiting

• Take herbal remedies for shortperiods only, because the effects oflong-term use are not yet known.

• Avoid complementary medicines ifyou are pregnant or breastfeeding.

• Some remedies may interact withconventional medicines; consult yourdoctor before taking them.

• If you have any doubts, consult ahomeopath or herbalist for advice.

• Do not stop taking a prescriptionmedicine unless advised to do soby your doctor.

• Never give a child more than thestated children’s dose of a medicine,and do not give a child even a smallamount of a drug that is intendedonly for adults, unless advised todo so by a doctor.

• Tell your doctor if you have takenor are taking any homeopathic orherbal remedies.

ECHINACEAUse this herb to protectagainst infection and torelieve the symptoms ofcolds, coughs, and flu

LAVENDER OIL This aromatherapy oileases headaches and

aids relaxation

VALERIANThis herbal remedyaids relaxation and

induces sleep

GARLICGarlic is a herbal remedythat wards off infectionand maintains a healthy

heart and circulation

164 FAMILY ILLNESS

2Relieve fever• Drink plenty of cool fluids.

• Reduce temperature and relievediscomfort with an over-the-counteranalgesic such as acetaminophen.

• Give babies over 3 months of ageand children under 12 years liquidacetaminophen (not aspirin).

• Cool young children by removingmost of their clothing, wipingthem with a washcloth moistenedwith tepid water, and fanning them,but do not let them get too cold.

• Children under 5 years oldare susceptible to febrile

seizures (p.43) if theyhave a high fever

and shouldbe watchedvery closely.

Caring for a sick personWhen looking after a sick person at home, whether a child or an adult, yourmain concerns will be to ensure that he or she is comfortable and drinking plentyof fluids, that you provide the correct medication at the right time, and that anynew or worsening symptoms are dealt with correctly. A sick child or baby canbe more demanding, but loving, patient care is one of the best aids to recovery.

BRINGING DOWN A FEVER

SOOTHING A SORE THROAT

• Rest your voice by speaking as littleas possible.

• Drink plenty of fluids, especiallyhot or very cold drinks.

• Eat ice cream and icicles; they helpease a tickly throat.

• Take analgesics, such as acetaminophenor ibuprofen, in the correct doses.

• Suck throat lozenges containing alocal anesthetic (these are suitableonly for adults).

• Gargle warm salt water (half ateaspoon of salt in a glass of water).

• Install a humidifier or place bowlsof water near radiators to keep theair moist.

Providecoolfluids

Use fan tokeep roomcool

Removeclothing andbedclothes

Check temperature• A fever is a body temperature that

is above 100.4˚F (38˚C). See pp.68and 70 for advice on the differentways of measuring a temperature.

• If you or your child develops afever, look at the charts on pp.74and 76 to check whether medicalhelp is required or whether thecause can be treated at home.

1

Wipe skin withtepid washcloth

165CARING FOR A SICK PERSON

PREVENTING DEHYDRATION

• If you have a fever or are sufferingfrom vomiting and diarrhea, drinkplenty of fluids every 1–2 hours,such as diluted orange juice, weaksweetened tea, or an over-the-counterrehydration solution, which containsessential minerals and glucose.

• Do not give milk to adults, children,or bottle-fed babies if they aresuffering from diarrhea or vomiting.

• If a breastfed baby is affected,continue to breastfeed and offerthe baby extra fluids.

Give fruit-flavoredrehydratingfluids to drink

RELIEVING ITCHINESS

RELIEVING A BLOCKED NOSE

• For itchiness caused by dry skin,moisturize the skin by applyingemollients, such as aqueous creamand petroleum jelly, after washingand bathing.

• To soothe severe itching caused bychicken pox, apply calamine lotionto the spots.

• For severe itching, apply topicalcorticosteroids sparingly to the area.Always follow the manufacturer’sinstructions with corticosteroids.

• Fill a bowl or basin with hot waterand lean over it with a towel pulledover your head. Breathe deeply.

• Alternative methods are to rub avapor ointment on the chest or touse decongestant capsules that arefilled with menthol and otherstrong-smelling oils.

Soothe itchy skinby dabbing withcalamine lotion

Important• Do not give steam inhalation treatment to

young children.

• Older children should undergo steaminhalation treatment only if supervised.

!

166 FAMILY ILLNESS

ADMINISTERING EYEDROPS

To yourself• Wash your hands thoroughly before

using the drops.

• Tilt your head backward anddraw the lower eyelid away from the

affected eye.

• Drop the eyedropsonto the insideof your lower lid,being careful notto touch the eyeitself or the skinaround it withthe dropper.

• Try not to blinkright away.

To a child• Wash your hands thoroughly before

using the drops.

• Sit down and lay the child acrossyour lap, holding his or her headsteady. Ask another person tohelp you if necessary.

• Draw the lower eyelid awayfrom the affected eye anddrop the eyedrops on tothe inside of the lower lid,taking care not to touchthe eye or the skin aroundit with the dropper.

• Ask the child to try notto blink right away.

To a child• Wash your hands thoroughly

before using the ointment.

• Draw the child’s lower eyelid awayfrom the affected eye.

• Squeeze a thin line of ointmentalong the inside of the lower eyelid.

• Ask the child to close the eye briefly.

• Explain to the child that his or hervision may be temporarily blurred.

To yourself• Wash your hands thoroughly before

using the ointment.

• Draw your lower eyelid away fromthe affected eye.

• Squeeze a thin line of ointmentalong the inside of the lower eyelid.

• Close your eye briefly.

• You may find that your vision istemporarily blurred.

ADMINISTERING NOSEDROPS

To a child• Lay the child on her back with her

head tilted back. If she is a veryyoung child, hold her arms.

• Hold her head still and drop thenosedrops into the nostril.

• Encourage her to sniff upthe drops, so that they donot run out when shesits up.

To yourself• Lie down on a bed with your head

tilted backward.

• Drop the nosedrops intothe nostril.

• Sniff up the drops, so thatthey do not run out whenyou sit up.

• Lie still for a few minutesto allow the drops to settle.

ADMINISTERING EYE OINTMENT


ADMINISTERING EARDROPS

To a child• If the drops are being

kept in the refrigerator,allow them to warm toroom temperaturebefore using them.

• Lay the child on hisside. Hold hishead firmly as yousqueeze the dropsinto the ear canal.

• Keep his head stillfor a minuteto allow theeardropsto settle.

To yourself• If the drops are being kept in the

refrigerator, allow them to warmto room temperature before

using them.

• Lie down or tilt yourhead and squeeze the eardrops into the ear canal.

• Keep your head stillfor a minute to allowthe eardrops to settle.

Hold child’shead still

3Deliver dose• Sit the child or baby on your lap,

place the mouthpiece in the child’smouth or the mask over the baby’sface and depress the inhaler.

• Hold the spacer in place until thechild or baby has taken five deep

breaths, which should besufficient to inhale all

of the medicine.

1Reassure• Stay calm and reassure the child

or baby because he may befrightened by the mask.

• An asthma attack can be frighteningnot only for the child or baby butalso for the adult caregiver.

2Prepare spacer• Check that the inhaler is

working by shaking it anddepressing it once.

• Place the inhaler in the holeat one end of the spacer.

• Attach the mask (for ababy or young child) ormouthpiece (for an olderchild) to the other endof the spacer if it is notalready in place.

GIVING ASTHMA MEDICATION TO CHILDREN

Depressinhaler Spacer

Hold maskover baby’sface

DEALING WITH A PANIC ATTACK

168 FAMILY ILLNESS

GIVING LIQUID MEDICINES TO CHILDREN

1Measure dose• Use a syringe or dropper to avoid

spillage and to ensure that yougive the correct dose.

• If you are unsure how to use thesyringe or dropper, ask your doctoror a pharmacist to show you howto measure and give a dose ofmedicine to a baby or child.

• Always measure out the dosebefore you pick up the childor baby; otherwise, you may notbe able to do the job.

1Calm person• Stay calm yourself and

take the personto a quietplace.

2Reassure childor baby• Hold the child or baby securely on

your lap to give reassurance andprevent possible struggling.

• Have a drink ready in case the tasteis unpleasant to the child or baby.

• If the child or baby is nervousabout taking the medicine, explainthat the drug will help him feelbetter and stress that it will allbe over very quickly.

4Deliver dose• Slowly press the plunger or squeeze

the dropper, allowing the child orbaby time to swallow. Do not aimdirectly down the child or baby’sthroat; this could cause choking.

• If the child or baby spits out themedicine, wait until he has calmeddown and then try again.

• Mix the medicine with a little jam,if this helps, but do not add it to adrink because it may stick to thesides of the cup.

Place in mouth• For a child, place the tip of

the syringe or dropper wellinside the mouth and angleit toward a cheek.

• For a baby,touch hislips with thesyringe or

dropper toencouragehim to open

his mouth.

2Treathyperventilation• If the person feels tingling in the

fingers, it may be caused by toomuch carbon dioxide in the blood.

• Encourage her to breathe moreslowly and to imitate you.

• Try holding a paper bag againsther mouth, so that she rebreathesher own expired air, until hersymptoms stop.

3


RELAXATION EXERCISES

Align your headwith your body

Rest on a pillowfor comfort

Rest your shoulderson the floor

Use your armsto support yourupper body

3Relax muscles• Lie down, put your arms by your

side, and let your feet fall open.

• Shut your eyes.

• Take one or two slow, deepbreaths. Focus on your breathing.

• Starting with your feet andworking up to your head, tensethe muscles in each part of yourbody, hold for a count of three,then release the tension.

4Finish by resting• When you have completed the

exercises, lie still for a fewmoments, keeping your eyes shut,then roll over onto your side.

• Draw your knees up slightly andbend your arms to support yourbody in a comfortable position.

• After a few minutes, open youreyes and get up slowly.

1Get ready • Performing breathing and muscle

relaxing exercises can help rid youof feelings of anxiety.

• Wear comfortable, unrestrictiveclothing.

• Choose a warm, quiet room foryour relaxation exercises.

• Prepare a firm yet comfortablesurface, such as an exercise mat orfolded blanket, and have somecushions nearby for extra support.

2Start withbreathing exercises• Put one hand on your chest and

the other on your abdomen.

• Inhale slowly, hold your breath fora moment, then exhale slowly.

• Try to breathe using your abdomenmuscles so that the lower handmoves more than the upper hand.

• Once you are breathing from yourabdomen, feel your lower handrise and fall with your abdomen.

Feel the gentlemovement ofyour abdomen

Sit on a cushionfor comfort

Fires, burst water pipes, sink blockage, and roof leakage are just a fewof the many household incidents that can occur in any home at any

time. By knowing how to cope with a wide range of householdproblems, and having the right equipment for the job, you can minimize

any damage to your home and danger to your family. Follow theinstructions to fix simple problems yourself by performing tasks such asreleasing air from a radiator or replacing a pane of glass. For jobs thatare less straightforward, learn how to create a temporary solution until

you can arrange for a professional to make a permanent repair.

3

HOUSEHOLDEMERGENCIES

Home safety ................172Yard safety...................178Fires in the home ........180 Gas leaks ......................184Plumbing problems...................186 Central-heating problems ................192

Air-conditioningproblems......................194 Electrical problems......196Structural problems ....200Insects and pests .........208 Furniture and furnishings...................210Home security .............212

172

Your home should be a place of safety and security, yet every year householdaccidents cause countless serious injuries and many deaths. By being aware of thepotential dangers and taking action to make your home as safe as possible, youcan do a great deal to reduce the risk of accident. The following room-by-roomguide highlights potential trouble spots and provides practical advice on sensiblesafety precautions. Most household accidents derive from carelessness, so workcautiously and wear safety equipment when undertaking do-it-yourself projects.

Home safetyHOUSEHOLD EMERGENCIES

MAKING YOUR HOME SAFE

3Work safely• If you are doing emergency

repairs, take all necessary safetyprecautions, especially if the workinvolves electricity.

• Wear safety equipment: gogglesto protect eyes from flying debris;dust mask to prevent dust fromentering the lungs; and ear plugs

to protect earsfrom the noiseof power tools.

1Be prepared• Assemble a basic emergency repair

kit (see box, right) and keep it inan accessible place.

• Make sure that all family membersknow where the equipment is kept.

• Check that the adults know whereto find and how to operate themain controls for gas (by the gasmeter), electricity (by the fusebox),and water (often located under the kitchen sink).

• Draw up a family evacuation plan(p.173) and practice it regularly.

• Near the telephone, keep a list ofphone numbers of an emergencyplumber and electrician, yourfamily doctor, and 24-hourhelplines for reporting gas andwater leaks.

ESSENTIALS

• First-aid kit (p.60)

• Flashlight and sparebatteries

• Lightbulbs

• Candles andmatches

• Plugs and fuses(p.197)

• Screwdriver

EMERGENCY REPAIR EQUIPMENT

2Prepare for fire• Install smoke and carbon monoxide

alarms or detectors (p.173).

• Keep a fire blanket and a drypowder fire extinguisher thatweighs at least 2 lb (1 kg) near thestove in the kitchen. Have theextinguisher serviced regularly.

• Buy a metal fire ladder to usewhen escaping.

Hold toolsfirmly formaximumcontrol

Wear goggles anda mask to protectagainst dust

173HOME SAFETY

MAKING A FAMILY EVACUATION PLAN

1Plan escape routes• Decide on the best route for escape

– this should be the usual way inand out of your home.

• Plan an alternative route to use ifthe normal way is blocked.

• If doors or windows need to beunlocked to escape, make sure thateveryone knows where to find theappropriate keys. Ensure that thedoors and windows open easily.

2Plan meeting point• Decide on a safe assembly point

outside the home where everyonecan meet following an evacuation.

• Make sure that the whole family isaware of how to escape and whereto meet after evacuation.

3Practice your plan• Walk through the escape routes

with family members so thateveryone knows what to do.

• Practice these escape routes on a regular basis, especially aftermaking changes in your home.

• Wear blindfolds during onepractice, to simulate dark andsmoky conditions, but be carefulwith young children and the elderly.

INSTALLING SMOKE ALARMS

1Choose alarms• Buy battery-operated or electrical

smoke alarms and take care tochoose a reliable brand.

• For added safety, choose linkedalarms, which set each other offwhen smoke is detected.

3Test regularly• Check once a month by pressing

the test button. Change the batteryin each alarm every 6 months.

• Vacuum the inside of eachregularly to keep the sensorchamber free of dust.

2Install• Attach alarms securely to the

ceiling at least 12 in (30 cm) awayfrom any wall or light fixture.

• If your home is on one level, put asmoke alarm in the hall; if it hasmore than one story, install one at the bottom of the stairs andanother on each landing.

!Important• Keep all escape routes free of furniture

and clutter.

• If you have overnight guests, tell them aboutyour evacuation plan so that they will knowwhat to do in the event of a fire.

INSTALLING CARBONMONOXIDE ALARMS

• Install one or two carbon monoxide alarmsnear sleeping areas and in any room with aboiler or a gas fire; these alarms emit a loudnoise when they detect the gas.

• Place carbon monoxide detectors next toboilers and gas fires; these detectorschange color if carbon monoxide is present.

174 HOUSEHOLD EMERGENCIES

• If you have a water heater in thekitchen, make sure that the flue iskept clear. If you use gas, install acarbon monoxide alarm in thekitchen, as close to the water heateras possible (p.173).

• Unplug or switch off electricalappliances at the wall when theyare not being used. Kettles, electricknives, and blenders are particularlyhazardous.

• Use a ladder to reach high shelvesinstead of standing on a stool, whichcould tip over.

• Never leave a skillet or deep fryerunattended on the stove (p.183).

• Ensure that work surfaces and sinksare well lit so you can work safely.

• If you have young children, installsimple security latches on cabinetsand drawers that contain hazardousliquids or objects.

• Store matches, sharp items, andhousehold chemicals well out ofthe reach of children.

• Try to keep young children out ofthe kitchen when you are cooking.

• Turn pan handles toward the wallso that children cannot grab themor accidentally knock them.

• Install guard rails around the stoveto keep children away.

• Warn children that stovetops –especially electric burners, whichmay show no signs of being hot –can burn even when the power is off.

• Store sharp knives well out of thereach of children, ideally in awooden knife block.

• Always switch off the electric ironand move it out the reach ofchildren when it is unattended.

• Wipe up spills as soon as possible.

MAKING YOUR KITCHEN SAFE

Turn pan handlesaway from thefront of the stove

Keep appliances near thewall and unplugged whennot in use

Store knivessafely in aknife block

Wipe up spilledliquids immediatelyand make sure thatfloors are dry beforewalking on them

Keep a fire blanket and fireextinguisher in the kitchenand make sure that youknow how to use them

Use the back burnersof the stove inpreference to thefront ones

175HOME SAFETY

• Avoid running electric wires acrossthe floor: these could be tripped on.

• Never run wires under a carpetwhere people walk; with wear, thecarpet may expose bare wires.

• Check all electrical wiring regularly:frayed insulation can cause fires.

• Don’t overload electric sockets with multi-point adaptors. Use anextension cable with four or sixsocket outlets instead.

• If you have an open fire, make surethat you use a fire guard, especiallywhen children are present.

• Secure carpets and rugs firmly sothat people cannot trip on them.If you have polished wooden floors,place nonslip mats underneath rugsso that they do not move.

• Always check an open fire beforegoing to bed at night and makesure that a fire guard is in place.

• Install a carbon monoxide detectorbeside a gas fire (p.173).

• Unplug or switch off electric fires andtelevisions at the wall socket at night.

• Empty all ashtrays and dispose oftheir contents safely at night.

• Ensure that halls and stairways arewell lit – especially if children orelderly people are likely to use them.

• Leave a nightlight on at night.

• If you have young children,install safety gates at the stairwayentrances, and keep them closed.

• Check for worn areas of carpet,which could cause trips or falls.

• Mats and rugs on parquet orpolished wood flooring can bedangerous. Place nonslip matsunderneath them to prevent themfrom sliding.

• Install extra grab rails on the stairsto assist elderly people.

• Keep the areas at the top and bottomof the stairs clear at all times.

MAKING YOUR HALL AND STAIRS SAFE

Put nonslip matsunder rugs toprevent slippingPut children’s toys

away after use

Do not let electricwires trail across thefloor or under thecarpet

Do not overloadelectrical outlets

Keep fire guardsaround the fireat all times

Secure bookcasesand other heavyfurniture to the wallsto prevent themfrom falling over

MAKING YOUR LIVING ROOM SAFE

176

MAKING YOUR BATHROOM SAFE

• Secure a grab rail on the wall abovethe bathtub to provide extra support– especially for elderly people.

• Run the cold water first whenpreparing a bath for young children.

• Never leave young children on theirown in a bath.

• Make sure that shower units arefitted with efficient thermostaticcontrols, so that there is no risk ofanyone being scalded.

• Store medicines in a locked cabinetout of the reach of children.

• Never use an electrical appliance,such as a hairdryer or radio, in a bathroom.

• Never touch an electrical item withwet hands.

• Make sure that bathroom lights andwall-mounted heaters are controlledby pull-cord switches or switchesoutside the room.

• Check gas water heaters regularlyto ensure that flues remain clear.Install a carbon monoxide detectoror alarm (p.173).

• Never mix two types of householdchemicals, such as bleach andbathroom cleaner. The combinationcan produce poisonous fumes.

• Keep all such chemicals out of thereach of children.

• Service electric blankets regularlyand check their wiring for wear and deterioration.

• Never leave electric blankets onovernight unless the instructionsmake it clear that it is safe to do so.They may overheat and catch fire.

• Keep a flashlight and your cellularphone (if you have one) by the bedat night, for use in an emergency.

• Never smoke in bed. You could fallasleep with a lit cigarette.

• Never drape a cloth over a bedsidelight to reduce glare. The heat fromthe bulb could cause a fire.

• Keep bedroom floors clear of clutter,especially if elderly people or youngchildren may get up to use thebathroom at night.

• If bedroom windows have locks, keepthe keys nearby – you may need touse windows as emergency exits. Ifpossible, leave bedroom windowsunlocked at night.

MAKING YOUR BEDROOM SAFE

Always test the watertemperature beforegetting into a shower

Install electricaloutlets in thebathroom forelectric razors only

Use non-slip matsin the shower and bathtub

Install a firm grabrail over the bathtub

Control wall-mountedbathroom lighting bypull-cord switches


177

• Never use pillows or comforters incribs for babies under 1 year old.

• Do not allow very young children tosleep on the upper level of a bunkbed; they may fall out.

• Make sure that there is no gapbetween the mattress and bed railthrough which a child could slip.

• When a young child moves out ofa crib, secure guard rails to the bedso that she cannot fall out.

• Make sure that there are no lampswithin reach of a child’s crib or bed.Lightbulbs get hot, and pullingon the wire could be dangerous.

• Install plastic covers over electricaloutlets that are not in use.

• Use plug-in nightlights so thatchildren can find their way if theyneed to get up in the night.

• Install removable window guardsthat allow windows to normally

open only slightly for ventilation,but fully during an emergency.

MAKING YOUR CHILD’S BEDROOM SAFE

• Never use freestanding stepladdersto ascend into the attic space: theytend to be unstable and are likely totip over. Instead, install an atticladder with a hand rail.

• Install a light in the attic, preferablycontrolled from the landing below.Choose a lightswitch that indicateswhether the attic light is on or off.

• Line the attic floor with floorboards,or attach veneered chipboard to therafters, so that you can store itemsand move around safely.

• Before storing heavy items, have acarpenter check that the rafters arestrong enough to support the extra weight.

MAKING YOUR ATTIC SAFE

Avoid feather pillowsand comforters asthey can provokeallergies

Keep bedroomfloors clear ofclutter

Put nonslipmats underrugs

Store heavier itemsaround the edgesof the attic floor

Use a pulldownladder for safety

• Protect ceilings underneath bydistributing the weight of storeditems. Put heavier boxes at the sides.

HOME SAFETY

178

PREVENTING ACCIDENTS IN THE YARD

• Remove or fence off any poisonousplants or trees in your yard.

• Keep children and animals awayfrom any area that has been sprayedwith weedkiller.

• Cover outside drains with metalgrills so that children’s feet will notget caught inside them. Grills willalso help prevent garbage fromblocking drains.

• Fence off ponds, swimming pools,and any other water features in theyard if the space is used by children.

• Do not attempt to use a wheel-barrow to move heavy equipment;it will be very unstable. It is muchsafer to use a cart instead.

• Don’t risk injuring your back bylifting a heavy load on your own –ask someone to help you.

• Never run a powerline along a fenceor bury it underground whenrunning electricity to a shed orworkshop. Use special shielded cableunderground, or run cable overhead,supported by a special wire. Whenin doubt, consult an electrician.

• For outside lighting and water-feature pumps, use a 12-volt systemwith a transformer and house it in adry shed or other outdoor building.

• When you are operating electricalpower tools, such as lawnmowersor hedge clippers, always secure acircuit breaker between the pieceof equipment and the power source.Make sure that you wear theappropriate safety gear, such assafety goggles, protective glovesand if necessary ear protectors.


Yards and outside buildings present many hazards, so safety is an essential partof yard maintenance. Check that garden yard boundaries are secure, especiallyif children or animals are likely to be outside; that paths and patios are free ofdebris; and that toolsheds and equipment are securely locked. Gardening itselfcan be a dangerous pastime, so make sure that you also take the necessaryprecautions when working with tools and machinery.

Yard safety

Water danger• Young children can drown in as little

as a few inches of water. Even abucket of water poses a danger.

• If you have a pond, take the precautionof stretching strong plastic nettingover the pond and securing it firmlywith wooden pegs.

• For complete peace of mind, considerfilling in a pond and choosing asafer water feature, such as asmall fountain.

• Make sure that any water barrelshave secure lids.

!

Wear safetygoggles toprotect eyes

Wear ear protectors if tools are noisy

Choose protectivegloves for yardwork

179

DO’S AND DON’TS

DO• Use a garage ramp

when you are workingbeneath a car.

• Wear a dust maskand goggles toprotect yourself fromdust when sanding.

• Store garden chemicalsand tools safely out ofthe reach of children.

MAKING PATHS AND PATIOS SAFE

• Uneven or broken pavement cancause people to trip and fall. Mendor replace cracked pave-ment as soon as possible.

• Icy steps are dangerous.Lay self-adhesive stripsof abrasive material onstep treads.

• Alternatively, coat thetreads with a mix ofsharp sand and exterior-grade PVA adhesive.

SECURING BOUNDARIES

• Make sure that boundary gates arekept locked and that bolts are wellout of the reach of young children.

• If a gate leads onto a road, secure alatch that a young child cannotoperate. Alternatively, fit a small boltout of sight on the outside of the gate.

• If you have dogs or young childrenwho use the yard, block off any gapsin hedges or fences through whichthey could escape.

• Remember that as dogs and childrenget bigger, fences may need to beraised or strengthened.

MAKING GARAGES AND SHEDS SAFE

• Always keep garages, workshops,and sheds securely locked.

• Store hoes, rakes, shovels, electricalequipment, and sharp tools, such assaws and knives, well out of thereach of children.

• Label all dangerous materials andensure that container lids or capsare firmly closed.

• Store garden chemicals, such aspesticides and fungicides, out ofthe reach of children. Never pourexpired chemicals down sinksor drains; dispose of them safely.

• Keep chemicals in their originalcontainers. Never store them inother bottles.

• Never install fluorescent lighting near moving machinery, because itproduces a faint strobe effect thatcan confuse the senses, making theuse of such machinery dangerous.

DON’T• Run a car engine in

an enclosed space.

• Leave a hot tool on awork bench to cooldown. Hang it upsomewhere out ofreach until it is cool.

• Leave unattendedpower tools pluggedin or switched on.

YARD SAFETY

Use a wire brush toremove slippery algae

• During the winter, watch for a build-up of algae slime, which can make

surfaces extremelyslippery. Cleanalgae-coatedwalkways with astiff brush andsoapy water,or use a high-pressure washer.

• Prevent algaefrom building upagain by treatingthe surface witha herbicide.

180

Statistics show that once fire takes hold, you have less than 3 minutes to escapethe flames and toxic smoke, and get to safety. With such a limited period oftime, it is vital to have organized safe escape routes from your home and to haveregular fire drills with the whole family. Install fire ladders to give you a betterchance of escaping from upper floors. If a fire is small, try to put it out yourselfusing water, a fire extinguisher, or a fire blanket. However, if the flames are stillburning after 30 seconds, you should leave the building immediately. To giveyourself advance warning of a fire, install smoke alarms on every floor of thehouse and make sure that they are tested regularly.

Fires in the homeHOUSEHOLD EMERGENCIES

ACTION PLAN

ACTION

OPEN WINDOWS ANDDOORS TO CLEARREMAINING SMOKE.

Yes

No

Do you have afire blanket orextinguisher

that you knowhow to use?

ACTION

EVACUATE BUILDINGAND DIAL 911 OR CALLTHE FIRE DEPT (see Escaping from adomestic fire, p.181).

Yes

No

Have youmanaged to

put outthe fire within

30 seconds?

Yes

No

Can you safelyenter the room

to assessthe fire?

Yes

No

Are you in thesame room as

the fire?START

Yes

No

Is the firesmall?

2Evacuate building• If possible, close internal doors

and windows as you go, to confinethe spread of smoke and fire.

• Do not open a door without firsttouching the door or its knob withthe back of your hand to see if it ishot. Heat indicates fire within thatroom, so choose another route.

• If there is thick smoke, place ahandkerchief over your mouth andnose, and crawl as low as possible.

• If fire or smoke blocks your escaperoute, find another way out.

• Once you are out of the building,meet at your agreed assembly pointand check that no one is missing.

1Alert the family• A smoke alarm may warn you of

smoke or fire, or you may see afire start. Check that everyone inthe home is aware of the fire andis leaving quickly.

• Follow the escaperoute chosen inyour evacuationplan (p.173).

181

DO’S AND DON’TS

DO

• Feel doors and doorhandles with the backof your hand beforeopening them.

• Close doors andwindows behind you.

• Keep keys by alllocked windows.

ESCAPING FROM A HOUSE FIRE

!

3Dial 911 or call thefire department • Tell the dispatcher your address, if

anyone is still inside the building,and if anyone is injured.

DON’T

• Use elevators.

• Jump from upstairswindows unless forcedor told (by the firedepartment) to do so.

• Underestimate thespeed at which a firecan spread.

FIRES IN THE HOME

If you are trappedupstairs• Move into a room where rescuers will

be able to see you.

• Close the door and wedge a blanketat its base to prevent smoke fromentering.

• Open a window and shout for help.

• Use a fire ladder (see box below).

!

Close doorsbehind you

Guidechildrento safety

USING FIRE LADDERS

• Following the instructions, extend and attachthe ladder to the building’s facade. If possible,attach the ladder so that it does not pass overlower windows; otherwise, there is a risk that you might climb down into flames.

• Help the elderly and children get onto theladder and climb down safely. Reassure themand tell them not to look down.

• Use the children’s harness that accompaniesthe fire ladder for a baby or young child.

182

PUTTING OUT CLOTHES ON FIRE


USING FIRE EXTINGUISHERSAND BLANKETS

• Point the nozzle of a dry chemical fireextinguisher at the base of the flames andsweep it from side to side. OR

• Take the fire blanket out of its container andgive it a shake to open it up.

• Hold the blanket up so that it shieldsyour hands fromthe fire.

• Drop the blanketonto the flamesand leave itthere until thefire is out.

1 Prevent flamesfrom rising• If someone else’s clothes are on

fire, force the person to the groundso that the flames do not rise upand burn his face and air passage.

• If your own clothes are on fire,lie down immediately toprevent the flames fromrising up and burning yourface and air passage. If youtry to run for help, themovement will simplyfan the flames.

1 Sound the alarm• Do not attempt to put out a fire

yourself unless the fire is small,you discover it early, and you havea fire extinguisher or fire blanket.

• If you have doubts, dial 911 and,if necessary, evacuate.

2Smother flames• Wrap yourself or the victim in a

thick wool or cotton blanket, rug,or coat to smother the flames. Do not use materials that containsynthetic fibers to tackle the fire.

• Roll yourself or the victim aroundon the ground until you are

sure that the flamesare extinguished.

2Protect yourself• Make sure that you can retreat

quickly and safely from the area ifthe fire gets out of control.

• If the fire is still burning after 30seconds, evacuate the house atonce and dial 911.

Use a thick woolenrug or blanket tosmother the flames

TACKLING A FIRE

Roll the victim onthe ground to ensurethe flames are out

183

PUTTING OUT AN ELECTRICAL FIRE

FIRES IN THE HOME

1 Approach fire • Turn off the heat supply.

• Do not attempt to move the pan:the flames may blowtoward you.

• Do not put wateron a fire that is ina skillet or deepfryer: the waterwill disperse theburning fat andspread the fire.

2Smother flames • Cover the flames with a fire blanket

(see box opposite). If you do nothave a fire blanket,use a towel ordishcloth that hasbeen wrung outin water.

1Switch off power• Unplug the burning appliance or, if

you cannot safely reach the wallsocket, turn the power off at the fusebox.

• If a computer monitoror television is onfire, the screen couldexplode: protect yourselfby approaching it fromthe back or the side.

PUTTING OUT A SKILLET FIRE

2Smother flames• Drape a fire blanket over

the appliance to stifle thefire, or douse the flameswith a dry chemical fire

extinguisher (seebox opposite).

DEALING WITH A CHIMNEY FIRE

1 Evacuate • Many chimney fires are explosive;

bricks become projectiles thatmove like cannonballs.

• Do not try to extinguish the fire.Evacuate the house immediately.

2Summon help• Dial 911 or call the fire

department immediately.

• Ensure that the chimney is checkedand cleared by a chimneysweepbefore you light another fire in the grate.

Place the fireblanket over theburning monitorfrom behind

Protect your handsas you approach aburning skillet

184

Natural gas is not poisonous but when combined with air, it becomes highlyexplosive and can destroy a home. Do not attempt to do gas repairs yourself.This is one of the few areas of domestic maintenance in which any kind ofrepair or remedial work must be performed by a professional. Because naturalgas has no smell, an artificial odor (methyl mercaptan) is added to both gaslines and tanks so that leaks can be detected quickly. If you smell escapinggas, you should take immediate action.

Gas leaksHOUSEHOLD EMERGENCIES

ACTION PLAN

ACTION

CALL GAS COMPANYIMMEDIATELY.

ACTION

WHEN THE ROOM ISWELL VENTILATED ANDYOU CAN NO LONGERSMELL GAS, RELIGHTTHE PILOT LIGHT.

ACTION

TURN THE BURNER OFFAND OPEN WINDOWSTO VENTILATE ROOM.

ACTION

TURN THE GAS OFF ATTHE MAIN AND CALLYOUR GAS COMPANYIMMEDIATELY.

ACTION

DO NOT TURN ONANY APPLIANCES ORLIGHTS. EXTINGUISHANY FLAMES.

Yes

No

Has a stove,boiler, or pilot

light gone out?

Outside

Inside

Can you smellgas inside oroutside the

home?

START

Yes

No

Are anyelectrical

appliancesor lights

turned on?

ACTION

LEAVE THEM ON, WITHTHE EXCEPTION OF ANELECTRIC FIRE, WHICHSHOULD BE TURNEDOFF. EXTINGUISHANY FLAMES ANDVENTILATE THE ROOM.

Yes

No

Has a gasstove burnerbeen left on?

2

3Check for leak• Check all gas appliances and turn

off the gas supply at the main(next to the meter) or on the gascylinder for bottled gas.

• Send family members outside untilthe smell of gas has disappeared.

4Summon help• If you cannot identify the source

of the leak, or can identify it butrealize you should not attempt tofix it, evacuate the home.

• Call your regional gas supplier’semergency number from outsideyour house.

• Keep the family out of the homeuntil the gas company advises youthat the danger has passed.

• Warn neighbors that you havedetected a gas leak.

• Once repairs are complete, do notforget to relight all the pilot lightsin the house.

1Avoid dangerof explosion• As soon as you smell gas, or if

you suspect that a gas applianceis leaking but you cannot smellanything, immediately extinguishany flames, such as cigarettesor candles.

• Switch off any electric fires.

• Do not touch any other electricalappliances, including lightswitches. Operating anythingelectrical could create a spark thatcould ignite a concentration of gas.

185

DO’S AND DON’TS

DO

• Extinguish any flamesand cigarettes.

• Ventilate the room.

• Check gas appliancesand pilot lights.

• Turn off the gas supplyat the main or on thegas cylinder.

IF YOU SUSPECT A GAS LEAK

DON’T

• Turn on any lights orelectrical appliances.

• Use your home orcellular telephoneuntil you are outside.

• Forget to relight pilotlights once the leakhas been fixed.

GAS LEAKS

Ventilate room• If you find a gas jet left on, turn

it off immediately. Open windowsand any external doors.

!Carbon monoxide alert• Carbon monoxide detectors either set off

alarms or they change color when they sense the presence of the gas in the air.These detectors should be installed nearboilers or other appliances using gas, such as gas stoves.

• When the siren sounds or the detectorchanges color, ventilate the room by openingexternal doors and windows.

• Switch off the leaking appliance (or turn offthe gas at the main if you are unsure of thesource). Call a professional to repair it.

186

Water in the wrong places can cause considerable damage, but the ability tomake emergency repairs can prevent a minor problem from becoming a disaster.In a plumbing crisis, knowing the basics, such as where to find your mainshutoff valve and how to drain the system, can make the difference.

Plumbing problemsHOUSEHOLD EMERGENCIES

ACTION PLAN

ACTION

GO UP TO THE ATTICAND CHECK FOR ABURST PIPE ORDAMAGE TO A WATERTANK. REPAIR IFNECESSARY (see Burstpipe, p.188, or Fixinga leaking water tank,p.187). CHECK THEROOF AND REPAIRLEAK (see Leakingroof, p.206)

ACTION

CALL THE BUILDINGSUPERINTENDENT OR CONTACT YOURLOCAL WATERDEPARTMENT

ACTION

IF A DISHWASHER ORWASHING MACHINE ISLEAKING, CHECKDOOR SEALS, SUPPLYAND DRAIN PIPES

ACTION

IF THE RADIATOR ISLEAKING, REPAIR IT(see Radiator leaking,p.193). IF A PIPE HASBURST, REPAIR IT (seeBurst pipe, p.188)

ACTION

IF YOU ARE STILL NOTSURE OF THE CAUSE OFTHE LEAK, TURN OFFTHE WATER AT THEMAIN SHUTOFF VALVE,DRAIN THE TANK, ANDCALL A PLUMBER

ACTION

GO UPSTAIRS ANDCHECK THAT ALL THEUPSTAIRS FAUCETS ARETURNED OFFYes

No

Is waterleaking fromthe ceiling?

Yes

No

Is water leakingfrom a kitchen

appliance?

Yes

No

Is a radiatoror pipe

leaking?

Yes

No

Is water comingfrom the attic

or roof?

Yes

No

Do you haveaccess to thefloor above?

START

187

LEAKING CEILING

1Turn off water main• Go to the main shutoff valve and

turn off the water.

2Drain system• Turn off the boiler to keep the

pipes from overheating.

• Run the faucets upstairs and flushtoilets fed by the water tank toreduce the water level in the tank.

4Find source of leak• If the water is coming through the

ceiling, check the room or theapartment above.

• If the water is coming from theattic area, check for a burst pipeor damage to the water tank andfix any leak (p.188 and below).If the pipes and tank are sound,look for holes in the roof itselfand repair if necessary (p.206).

3Relieve pressure• Use a bucket to catch water

leaking from the ceiling.

• If there is a hairline crack, enlargeit with a screwdriver to increasethe flow and reduce the weight of water onthe ceiling.

• If the ceiling isbulging, putmore bucketsin place, thenpunch a hole.

PLUMBING PROBLEMS

ESSENTIALS

• Pipe repair tape

• Pipe-thread sealtape

• Pipe wrench

• Sink plunger

• Vise grips

• Closet auger

• Bolts with rubberand metal washers

• Epoxy resin sealant

PLUMBING TOOL KIT

Dangers of waterand electricity• If water is dripping from a light fixture or

onto an electrical appliance, do not touchthe switch, the light fixture, or the appliance.Turn off the power at the circuit breaker orfuse box and call an electrician immediately.

!

FIXING A LEAKING COLD WATER TANK

Some homes have a tank witha pump for constant housepressure. Others may have arepairable reservoir in the atticor basement.

• Shut the main valve. Arrangefor disposal of cold water.

• Close the hot water valve atthe hot water tank. Then

open the drain valve of thecold water tank.

• Flush toilets, then open allcold water faucets.

• Plug a small hole by drillingand inserting a bolt withrubber stops on either side.For corner hole, wipe dry;use an epoxy resin sealant.

Put rubber andmetal washerson both sidesof the hole

Insert a boltinto the hole

Enlarge the crack inthe ceiling with ascrewdriver

188

BURST PIPE


1Locate frozen pipe• Water expands as it freezes, which

can cause old pipes to split openor a compression joint (where twolengths of copper piping arejoined) to push apart.

• If you have copper pipes, checkthe compression joints to see ifany have been pushed apart.

• If you have lead pipes, look for icewhere the pipe wall has cracked.

• Water pipes will freeze only in anuninsulated roof space, outside, orin a house with no central heating.

2

3Shut off watersupply• If a compression joint is destroyed,

it will need to be replaced.

• If the joint is damaged, shut off thewater supply to the pipe by closingthe gate valve. If the pipe does nothave one, turn off the main anddrain the entire water system byturning on all the faucets.

4Repair joint• Thaw the joint (see box below).

• Unscrew the joint, wrap teglontape around the threaded parts,then refasten the joint.

Wrap pipe repairtape around thedamaged pipe toseal it

THAWING FROZEN PIPES

• If, during winter, you turnon a faucet and no watercomes out, the pipe maybe frozen.

• Find the pipe that feeds it,and tap it gently with amallet; you will hear a dullthud at the frozen section,which may be bulging underthe pressure of the ice.

• Check the pipe carefullyfor any cracks.

• If there are cracks, thenproceed to step 2 abovebefore thawing the pipe.

• Use a hot-water bottle, hotcloths, or a hairdryer togently heat the pipe or joint.If the water inside boils, thepipe may burst.

• Do not use a blowtorchto thaw any type ofpipework: the intense heatis likely cause damage.

Apply gentle heatto the frozen area

!

Repair burst pipe• If the pipe wall is damaged,

wrap pipe repair tapearound the crack.

• Thaw pipe (see boxbelow) if necessary.

• Call a plumberto make apermanentrepair.

The teglon tape willstrengthen the seal

189

BLOCKED SINK

1

3Check main drain• If the pipe remains blocked, there

could be a problem in the drain.

• Call a drain cleaner to come andclear the drain.

2Check U-bend• For a U-bend with a drain plug (a

small capped outlet at the bottomof the U section), put a bucket inplace, then unscrew the plug usinga wrench.

• Wedge a piece of wood in the U-bend to keep itsteady as youwork. Clear anydebris, then replacethe drain plug.

• For a removable U-bend, unscrewthe joints and liftout the U section,draining the waterinto a bucket. Cleardebris from thepipe, then replacethe U section.

Unscrew both sidesof the U-bend toremove blockage

PLUMBING PROBLEMS

Place a bucket underneathto catch water

CLEAR BOTTLE TRAP

• If the sink is still blocked, place a bucketunderneath the bottle trap below thesink and unscrew the base.

• Push a clotheshanger or “snake”(aflexible length of metal) down the drainto try to push the blockage out.

• If this is unsuccessful, try working upthrough the trap bottom and along thewaste pipe. Try to pull any debris backtoward yourather thanpushing itfurther away.

• Replace thetrap baseand fastensecurely.

Use sink plunger• Smear petroleum jelly around the

rim of a sink plunger.

• Block the overflow outlet with apiece of cloth, then position theplunger over the drain. Run 2 in (5 cm) of water into the sink.

• Pump vigorously for a few minutesto clear a minor blockage.

• If this fails, usea commercialdrain cleaner orpour carbonatedsoda dissolvedin hot waterdown the drain.

Remove the baseof the bottle trap

Block the overflowoutlet with a cloth

Pump the plungerover the drain

190

LEAKING FAUCET


1Turn off water• A leaking faucet is both a nuisance

and a waste of valuable water.

• In cold weather, dripping watercan freeze in the pipes overnight,which may cause pipes to burst.

• In hard water areas, a faucet thatkeeps dripping may stain sinksand baths with mineral deposits.

• Before starting on any repairwork, turn off the water supply.

• Close the “speedy” on the pipe,if it has one.

2Call plumber• Most leaking faucets are caused

by faulty washers.

• You will need to remove the faucetcover to replace a washer, whichmay be tricky if you have modernfaucets that are complex in design.If you feel unsure about tacklingthe job, call a plumber.

AIRLOCK IN PIPE

1

2Turn on faucets• If you cannot find the air lock in

this way, turn all the faucets onfull to try to drive out the air.

3Use garden hose• If this fails, connect one end

of a garden hose to the faultyfaucet and the other end to amain-fed faucet, such as thekitchen sink faucet.

• Turn on the faulty faucet, thenthe main-fed one. The pressureof the main water as it enters thefaulty faucet should drive the airlock out of the pipe.

• When the pipe stops banging, turn off the faucets and removethe hose from the main faucet.

• Drain off the water in the hose,then disconnect the hose fromthe faulty faucet.

• If air locks occur repeatedly, call a plumber.

Release air• If no water comes out and the pipe

makes a banging noise when youturn on a faucet, there is probablyan air lock in the pipe.

• You may be able to release the airby using a rubber mallet totap along thepipe leadingfrom thefaucet.

SILENCING DRIPS

• Until a faucet can be repaired, silence thenoise by tying a piece of string around itsspout. Put the other end of the string inthe drain. The water should now trickledown the string and into the drain.

Tap the pipegently to dislodgethe airlock

191

BLOCKED TOILET

1

2Try water force• If this fails, bail some water out

of the bowl to reduce the level.

• Pour a bucket of water into thetoilet. If the blockage is minor,the force of the water rushingdown into the bowl can beenough to dislodge it.

3Use plunger• If the toilet is still blocked, get

a toilet plunger or improvise bytying a plastic bag around thehead of an old mop.

• Pump the plunger up and downin the bowl, but be careful not touse too much force: you riskcracking the bowl.

• If the toiletremains blocked,or you prefernot to tryany of thesetechniques,call a plumber.

PLUMBING PROBLEMS

Try to clear toilet• If the contents of the toiletbowl do

not flow away when the toilet isflushed, the toilet is blocked.

• Do not keep flushing in the hopethat this will remove the blockage:water may build up in the bowland overflow.

• Use a bent wire coat hanger or asnake to remove a blockage justbeyond the bend.

DRIPPING OVERFLOW PIPE

1

3Call plumber• If the valve is broken, you will

need to call a plumber to repair it.

2Check float valveand float• Check the float valve first. If the

washer is worn, water will continueto trickle into the tank or cisterneven when the float has reached its uppermost position.

• Examine the float to see if itis leaking. Give it a shake to seewhether there is water inside.

• If necessary, buy a new washer orfloat to replace the faulty one.

Locate problem• A dripping overflow pipe from

a water tank or toilet cisternindicates that the correct waterlevel is not being maintained.

• Do not ignore a dripping overflow:the drip could suddenly turn into aserious leak, which could cause aflood, or the water may freeze andresult in a burst pipe.

• Look in the water tank or liftthe cover of the cistern. Floatingon the water is an object attachedto the tank or cistern side. Thisfloat is joined to a float valve,which should close off the supplyfrom the main when the tank orcistern is full.

Plunge firmly butcarefully so that youdo not crack the bowl

192

A hot-water heating system – which is composed of a boiler and circulator,radiators or baseboard, and an expansion tank – can stop working if thecirculator jams, or if a radiator develops a leak or has air trapped in it.Dealing with these problems is usually straightforward. Use the actionplan to identify the problem, then follow the instructions on the oppositepage. Alternatively, call a plumber or heating specialist.

Central-heating problemsHOUSEHOLD EMERGENCIES

ACTION PLAN

ACTION

RESET THERMOSTATSOR TIMER

ACTION

BLEED RADIATOR(see Radiator notworking, p.193)

ACTION

CHECK VALVE IS OPEN(see Radiator notworking, p.193)

Yes

No

Is the circulatorpumpingwater?

Yes

No

Is any part ofthe radiator

warm?

Yes

No

Are the timerand thermostats

set correctly?

ACTION

CALL IN A PLUMBERTO FIX YOUR SYSTEM

ACTION

TRY RELEASING AN AIRLOCK IN THE PUMP(see Circulatorjammed, p.193)

ACTION

REPAIR JOINT (seeRadiator leaking,p.193)

Single radiatornot working

No radiatorsworking

Radiator orjoint leaking

What is yourheating

problem?START

ACTION

SEAL HOLES INRADIATOR (see Radiatorleaking, p.193)

Joint

Radiator

Is the joint orthe radiator

itself leaking?

193

RADIATOR NOT WORKING

CENTRAL-HEATING PROBLEMS

1Check valve• Check that the valve at the bottom

of the radiator is fully open.

2Check thermostats• Look at the main central heating

thermostat and the radiator’sown thermostat (if present) tocheck that both are set correctly.

3Bleed radiator• Install an air bleed key on the air

bleed valve at one end of the topof the radiator.

• Hold a cloth underneath the valveand turn the key counterclockwiseuntil you hear air hissing out.

• Turn the key clockwise as soon aswater, which may be hot, startsdripping out.

1Find leak• Pinpoint the source of the leak.

Water can escape through a loosejoint between the pipe and radiator;or through tiny holes in theradiator, caused by corrosion.

2Repair joint• Tighten the nut with a pipe wrench.

• If water still leaks, turn off theheating and call a plumber.

3Seal small hole(s)• Run a hose from the central

heating drain valve (usually underthe boiler or on the last radiator in the system) to a drain or sink,then drain the system. The sealantflows through and seals the leak.

• The sealant is only a temporaryrepair, so replace the radiator soon.

RADIATOR LEAKING

1Find valve• Turn off the circulator (this will

be near the boiler) and find thebleed valve.

• Place a screwdriverin the bleed valveand have a clothready to catch thewater that will bereleased when theair lock is released.

2Release air lock• Expel any air from the circulator

as if you were bleeding aradiator (see above).

• If the circulator isstill jammed, call aplumber or centralheating specialist.

CIRCULATOR JAMMED

Turn bleed valveto release air lock

194

Air-conditioning problems

ACTION PLAN

There are two main types of air conditioning: central systems and single-roomunits. Both circulate clean air that is cool in the summer and warm in the winter.Problems with central air conditioners are generally best dealt with by an air-conditioning specialist, but you can usually perform basic maintenance ofroom units yourself, such as checking thermostat settings, cleaning the filter,repositioning the sensor, and cleaning the condenser.

ACTION

THE SENSOR OF AROOM UNIT MAYNEED REPOSITIONINGOR THE CONDENSERMAY NEED CLEANING(see Air conditionercuts out, p.195).

ACTION

SUSPECT THAT A FUSEHAS BLOWN. CHANGETHE FUSE (p.197).

ACTION

THE THERMOSTAT MAYNEED RESETTING(see Inefficient airconditioner, p.195).

Yes

No

Are the doorsand windows

open?

Yes

No

Is the systemor unit

humming?

Yes

No

Is the fanblowing?

ACTION

CLOSE THEM.

ACTION

THE FILTER MAYNEED CLEANING(see Inefficient airconditioner, p.195).

ACTION

IF YOU STILL HAVE NOTSOLVED THE PROBLEM,ASK A SPECIALIST TOCHECK THE SYSTEMOR UNIT.

START

Yes

No

Does thesystem or unitcut out or have

short cycles?

Yes

No

Is thethermostat

set correctly?


195

INEFFICIENT AIR CONDITIONER

AIR CONDITIONER CUTS OUT

AIR-CONDITIONING PROBLEMS

2Remove filter• If the fan is working efficiently

but the room or house is still toowarm, the filter may need eithercleaning or replacing (dependingon the type of air conditioner).

• For a central system, ask an air-conditioning specialist to clean orreplace the filter, as appropriate.

• For a room unit, unplug the unitat the wall. Remove or lift up thefront panel, depending on thedesign, and remove the filter.

3Clean filter• Clean the filter with some warm

water containing a mild detergent,then rinse it in clean water anddry it thoroughly.

• Replace the filter and turn theunit back on.

4 Install new filter• If your unit has a disposable filter,

check its condition. If it has turnedblack, is warped, or has holes init, then it needs replacing.

• Remove the old filter and replaceit, following the manufacturer’sinstructions. Then replace the frontpanel, and turn the unit back on.

1Reset thermostat• If the air conditioner is switched

on but the fan is not blowing,check the temperature setting onthe thermostat. If the thermostatis set too high for the currentconditions, the air conditionerwill not be stimulated to operate.

• Reset the thermostat to a lowertemperature. The fan should startto work right away.

1Reposition sensor• For a room unit, unplug the unit

at the wall. Remove the frontpanel and filter.

• Check the thermostatic sensor; itshould be near, but not touching,the evaporator coils. Move it awayfrom the coils if necessary.

• Replace the filter and front paneland plug in the unit.

• For a central system, get anair-conditioning specialist toreposition the sensor for you.

2Clean condenser• For a wall-mounted room unit,

remove the condenser (the partof the unit outside the room) first.The condenser in a window-mounted room unit can becleaned in place.

• Use a vacuum cleaner to removethe dust and lint that has collectedon the condenser.

• For a central system, get an air-conditioning specialist to clean thecondenser for you.

Clip filter backinto place aftercleaning

196

Electrical problems

ACTION PLAN

ACTION

PLUG A WORKINGAPPLIANCE INTO THEOUTLET. IF APPLIANCEFAILS, REPLACE THEOUTLET (p.199)

ACTION

CHECK THE CIRCUITBREAKER BOX FOR ABLOWN FUSE OR“OFF” CIRCUIT (p.198)

ACTION

REPLACE FUSE ORREWIRE PLUG IFNECESSARY (p.197)

ACTION

CALL AN ELECTRICIAN

ACTION

THERE IS PROBABLYA LOCAL POWERFAILURE. REPORTPROBLEMS TO YOURELECTRICITY SUPPLIER

Yes

No

Do yourneighbors

have power?

ACTION

TURN ON MAINSWITCHES ANDCIRCUIT BREAKERS

Several

One

Has oneelectrical

appliance orseveral failed?

Yes

No

Are lights orappliances inonly one area

affected?

Yes

No

Have youchecked boththe plug andfuse (p.197)?

Yes

No

Have you lostelectricity

throughoutthe house?

No

Yes

Are the mainswitches and

circuit breakersswitched on?

START

We all take electricity for granted – flick a switch and a light comes on, plugin the television and it works – but fuses can blow, electrical equipment canmalfunction, and wiring can become damaged or overheated, posing a potentialfire hazard. By equipping yourself with some basic electrical knowledge, you willbe able to rectify common problems quickly when they occur.


197

FAULTY APPLIANCE

1Check plug• Loosen the large screw between the

pins and remove the plug cover.

• Check the wiring inside the plugfor loose connections.

• Check that each wire is securelyattached to the correct terminal –black to Hot, white to Neutral, andbrown (if present) to Ground (seeRewiring a plug, below).

• If the plug is a sealed unit, you willhave to call an electrician to checkwhy the appliance is not working.

2Check fuse• Turn off appliances on the circuit,

if known.

• Locate the fuse box and examinethe filament strips visible throughthe mica window of each fuse.

• A blown fuse has a melted strip,seen through a halo of smokymetallic residue.

• Unscrew the threaded ceramic fusefrom its receptacle, and replace itwith one of the same amperage.

• Turn fixtures and appliances onagain, one by one.

DO’S AND DON’TS

DO

• Turn off appliancesat the wall outletwhen not in use.

• Switch off the walloutlet and removethe plug before youattempt to repairan appliance

• Have your wiringchecked by aprofessional at leastonce every 5 years.

DON’T

• Touch plugs, outlets,or switches if yourhands are wet.

• Replace a blown fusewith one of higheramperage: this canresult in overheatedwiring and fire.

• Attempt electricalwork unless you areconfident that youknow what to do.

ESSENTIALS

ELECTRICITY TOOL KIT

• Flashlight and batteries

• Spare plugs

• Plug fuses

• Fuse wire (for rewirable fuses) or cartridgefuses (for replaceable fuses)

• Outlet analyzer

• Voltage tester (for checking whether liveelectricity is present)

• Small screwdriver

• Wire cutters/strippers

REWIRING A PLUG

• Remove the plug cover,loosen the terminal screws,and ease out the cord.

• Position the cord on theplug with the wires placed intheir correct positions togauge whether you need toremove any of the cord’souter insulation.

• If necessary, use wire strippersto cut away 2 in (50 mm) ofthe outer insulation, thenreposition the cord.

• Cut each wire to length (eachone should be long enoughto reach its terminal) and usewire strippers to remove 1⁄4 in(6 mm) of insulation fromthe end of each wire.

• Replace the cord in theplug, fit the cord griploosely, and push each wirecarefully into its terminal.

• Tighten each terminal screwdown on to its wire and refitthe plug cover.

ELECTRICAL PROBLEMS

Neutral wire (white)

Ground wire(brown)

Hot wire(black)

198

ELECTRICAL CIRCUIT FAILURE

1 Look for faultycartridge fuses• When power fails in one part of

the house, turn off the affectedappliances and lights right awayand then go to the service/fuse box.

• If the service has cartridge fuses,turn off the fuse box toggle switchand open its cover.

• You will need to determine whichfuse has blown using a continuitytester. Remove each fuse, touchone end with the alligator clip ofthe tester, and the other with theprobe. If the bulb of the testerdoes not light, the fuse is blown.

• Replace the blown fuse(s) with oneof the same amperage.

2Check circuitbreakers• Most modern homes are now

equipped with circuit breakerswitches instead of less consumer-friendly ceramic, cartridge, orrewirable fuses. Many local codesrequire them because they arenot as prone to consumer errorin replacement.

• Most circuit breakers have a keyidentifying the rooms affected byeach switch.

• If your unit has miniature circuitbreakers (MCBs), look for one inthe “off” position and simply flickit back on, or push the reset button.

Identify recurrentfault• If the MCB switch will not stay in

the “on” position, or the fuse blowsagain when you turn the powerback on, try to identify the fault.

• Check to see whether any lightbulbs have blown, then switch offall appliances on that circuit andswitch them back on one at a time.

• If you cannot find the cause of theproblem, call an electrician.


Replacing fuse wire• Rarely, some homes will have fuses

with replaceable wires. These mustbe replaced with wires rated with thesame gauge as the melted one! Callan electrician to check the service andto replace fuse wires.

• Never use any conductor (wire, strip,coin, or foil) as a substitute for a fuseor fuse wire.

!

Replacethe faultycartridgefuse

Push the switchback to the

“on” position

3

2

199

FAULTY WALL OUTLET

1

2Check inner wires • Unplug the cord at the wall.

• If the inner wires are damaged,do not use the appliance until anelectrician has replaced the cord.

3Make repair • If the inner wires are undamaged,

wrap insulating tape around thecord as a temporary measure untilan electrician can replace it.

1 Look for signsof damage• If the sheathing on an electrical

cord is damaged or worn, youcould be electrocuted if youtouch the exposed inner wires.

ELECTRICAL PROBLEMS

WORN ELECTRICAL WIRE

Extend thetape beyondthe damagedarea onboth sides

Wrap the tape inoverlapping layers

Look for signsof damage• Check for scorch marks on an out-

let or around the base of plug pins;these indicate poor connections.

• If you have already checked orfixed the plug (p.197), and theappliance works in another socket,the outlet is probably faulty andwill need to be replaced.

• If any part of the outlet is wet, donot attempt to replace it – ask anelectrician to do it for you.

Replace outlet • If possible, buy a new outlet that

is identical to the old one so thewires will be in the same place.

• Switch off the power at the circuitbreaker/fuse box and take out therelevant fuse (or flip the switch tothe “off” position if your unit has MCBs).

• Remove the fixing screws from the outlet and pull it out of itsbracket. Note which wires lead towhich outlet terminals.

• Loosen theterminals to freethe conductorwires, thenconnect the wiresto the correctterminals of thenew outlet.

• Put the new outletinto the oldmounting bracketand screw it into place.

Reconnect thewires to thenew outlet

200

Structural problemsHOUSEHOLD EMERGENCIES

Most structural problems can be prevented by performing regular internaland external maintenance checks. Look at the condition of your windows,doors, roof, walls, fences, and drains, and deal with minor defects immediatelybefore they become major problems. Even in a well-maintained home, however,there is plenty that can go wrong – windows get broken, doors stick, roof tilesfall off, and holes appear in gutters – but the advice here will help you at leastmake a temporary repair before seeking expert advice.

SECURING BROKEN PANE OF GLASS

1Make cracks safe• If the glass is cracked, cover the

crack(s) with clear, self-adhesivewaterproof repair tape on bothsides of the glass to hold ittogether temporarily.

• Either replace thepane yourself (seeopposite) or get aglazier to do thejob for you.

2Cover shatteredpane• If the glass is shattered, cover the

outside of the hole with a sheet ofpolyethylene and secure it to the

frame with battens andpins or strong tape.

• For greater security,screw a sheet of 1⁄2-in(12-mm) thick ply-wood over the insideof the broken door orwindow pane.

• If you feel that youcan do the job, replacethe glass yourself (seeopposite), or ask aglazier to do it for you.

CHOOSING AND MEASURING FOR REPLACEMENT GLASS

• Safety glass is reinforced in manufacture and mustbe used when glazing a very large area, such asa patio door or picture window, where it couldbe mistaken for an opening, or where glass willbe fitted within 31 in (80 cm) of the floor.

• There are three types of safety glass: toughenedglass, laminated glass, and wired glass. If youneed to use safety glass, discuss with your glassmerchant which type is most suitable for thewindow or door in question.

• If the glass is patterned, take a piece to matchwith the new glass.

• Measure the height and width of the opening,going right into the groove cut for the glass inthe frame. Cut away any old putty or removeold bead to make sure. Since the cavity may notbe square, take two measurements on eachdimension and use the mid-point as your figure.

• Measure the two diagonals of the opening.If they are not the same, make a cardboardtemplate to give to your glass supplier.

• Buy a pane of glass that is 1⁄8 in (3 mm) smallerthan the cavity on each dimension; also buysome putty and some glazing points.

Tape over thecracks carefullyto avoid breakingthe glass

201STRUCTURAL PROBLEMS

2 Insert new glass• Wet your hands and then knead

some putty to make it pliable.Working on the outside of thewindow, press a continuous puttyline all around the edge where theglass will rest using your thumb.

• Place the glass, lower edge first,on to the putty and press it firmlyinto place, leaving a 1⁄8-in (3-mm)gap all around.

3Secure new glass• Fix the glass into position with

glazing points spaced about 20 cm(8 in) apart. Tap them gently intothe frame with a small hammer,ideally a pin hammer.

• Remove any surplus putty on theinside edge of the glass with a wetputty knife (a small, pointed,wide-bladed knife).

• Roll some more glazing putty intoa thin sausage and press it into thejoin between glass and frame allaround the outside of the window.

• Smooth it by holding the puttyknife at a 45° angle to the frame,with the flat of its blade on theputty, and pulling it along. Miterthe corners.

• Allow the putty to dry for at least2 weeks before painting.

• If the glass is held by beading, applya strip of self-adhesive plastic foamaround the outside edge of the glassbefore pinning on the beading.

• Repaint the frame, brushing a 1⁄8-in (3-mm) margin of paint ontothe glass to ensure that rainwaterwill not get behind the putty andinto the wood frame.

REPLACING DAMAGED PANE OF GLASS

1Remove old glass• Put on strong protective gloves

and safety glasses.

• If the glass is only cracked, run aglass cutter around the edge about1 in (25 mm) from the frame. Placeself-adhesive tape across the cracks,then tap the glass with a hammer.It should come away in one piece.

• If the glass is shattered, sweep upthe debris, then pry out any loosepieces still in the frame. Use an oldchisel and hammer to remove piecesfrom around the edges, with theold putty. Work from the top ofthe frame downward.

• Use pliers to extract the glazingsprigs (the tiny nails used to holdthe glass in place), then brush theframe to remove small fragments.

• Dispose of the broken glass safely.

Keep the hammer head parallelto the pane of glass

Press until theputty squeezesout on theinside ofthe glass

Press aroundthe edges, notin the middle

202

DOORS AND WINDOWS THAT STICK

DAMAGED WINDOW JOINTS


1Remove paintlayers• A build-up of paint layers can

cause doors and windows to stick.

• Strip off all the paint back to barewood, then repaint.

2Plane door• If a door or window catches

as you close it, take it offits hinges, plane alittle off the top,bottom, or side,depending onwhere it catches,then rehang it.

3Prevent dampness• A door that is sticking in damp

weather but fits perfectly well indry weather is absorbing moisture,probably through an unpaintedtop or bottom edge. Ideally, waitfor dry weather before painting it.

• If the bottom edge of a door isunpainted, take the door off its

hinges, then paint allthe surfaces andrehang it.

• If this does not solvethe problem, plane thesticking edge, smoothit with sandpaper, ifnecessary, then paintand rehang as before.

Plane to bare wood onthe edge that is sticking

Place the jointin a pipe clampand leave untilthe adhesivehas dried

1Make temporaryrepair• Joints that shrink as the wood dries

out can cause a window to sag.

• A sash window will need to beremoved for repairs (see step 2).

• A prominent casement window canbe temporarily repaired in placeuntil you have time to makea permanent repair (see step2). If the window is not in aprominent position, mostrepairs can be done in place.

• Unscrew the frame a littleand then pry the loose jointopen slightly. Squeeze somePVA woodworkingadhesive into the gap.

• Screw an L-shaped metalbracket across the joint tohold it together.

2Make permanentrepair• For a permanent, and more sightly,

repair, remove the window andunscrew the frame.

• Pry the loose joint open andsqueeze some PVA woodworkingadhesive into the gap.

• Hold the joint in an adjustablesash clamp until it has set, thenreplace the window.


DAMAGED SASH WINDOWS

1 Ease sticking parts• If a sash window sticks a little, rub

a candle on to the sliding parts andput oil on the pulleys.

• If the window is sticking badly, itis likely that a joint has dried outand needs repairing (p.202).

2

BADLY FITTING HINGES

1Replaceprotruding screws• Check the hinge screws. If the

heads are protruding, a door orwindow will not close properlyagainst the frame. Try screwingthem in more tightly.

• If this is unsuccessful, replace anyprotruding screws with smaller-diameter, longer screws.

4

3Tighten screws• If a hinge is too loose, the door

or window will not hang properly.Tighten loose screws or replacethem with longer screws.

2Shim a hinge• If a hinge is recessed too far into

the frame, the door or windowwill not close properly.

• Take the door or window off itshinges and remove the hinge.

• Shim the recess with a piece ofcard the same size as the hinge.

• Replace the hinge and rehang thedoor or window.

Damaged orbroken sash cords• If the sash cords have broken,

so that the top window crashesdown, you will need to get themremoved and replaced.

• In the meantime, you can makethe window safe by using lengthsof wood to wedge it shut.

• Replacing sash cords is not easy or a job for the amateur becausereplacement cords must be fittedwith the correct weights. Get a window repairer to do the job for you.

Gain a hinge• If a hinge is insufficiently recessed

into the frame, the door or windowwill not close properly.

• Take the door or window off itshinges and remove the hinge.

• Use a wood chisel to carefully cuta deeper recess for each affectedhinge, then replace the hinge.

Rub candlewax againstthe recess

Enlargethe hingerecess

204

DEALING WITH WOOD ROT

2Treat cause ofwet rot• Before repairing damaged wood,

try to find out why the wood hasbecome damp. Check for a leakypipe or blocked drain.

• Fix the cause of the dampness andlet the wood dry.

1Assess damage • Rotten wood at the foot of doors or

around window frames is usuallycaused by wet rot.

• Wet rot occurs when wood getsdamp, often when water has seepedthrough damaged paint. A firstsign is often peeling paint.

• If you can detect a strong, musty,mushroomy smell indoors, or see awhite, cottonlike material belowkickboards or through floor-boards, you may have dry rot.

• Dry rot affects wood in badlyventilated confined spaces, andit spreads rapidly. Call in rottreatment specialists immediately. 5Fill hole

• For extensive damage, use newwood, treated with preservative,to fill the main gap.

• For smaller gaps, use a specialtwo-part wood filler, followingthe manufacturer’s instructions.Use wood filler also to fill anygaps around new wood.

• Once the filler is dry, rub it downwith sandpaper until smooth, thenpaint, stain, or varnish.

3Cut awaydamaged wood• Chisel out all the decaying material

until you reach sound, solid wood.

• Coat the sound wood andsurrounding woodwork with a chemical wet rot treatment.

4 Apply woodhardener• Brush a coat of wood hardener

on to the exposed wood. Thisvarnishlike liquid binds the loosefibers of wood together and sealsthe surface, making it ready forreplacement wood or filler.


A sign of wet rot iswood that is darkbrown and crumblywhen dry

A cotton-wool likematerial and rust-colored sporesindicate dry rot


BROKEN OR UNSTABLE FENCING

BROKEN OR UNSTABLE GATE

1

1 Replace post• A rotten gate post should be

replaced by a new wooden post(see Replace post, above).

3Secure hinges• If a gate is sagging, the hinges may

need to be secured using longer orthicker screws.

2Make gate stable• If a gate is generally unstable,

check the diagonal brace on itsback. If the brace is not sound,replace it with a new one.

• Alternatively, if a joint is loose,open the joint slightly and squeezesome waterproof adhesive into it.Use a metal bracket to keep thejoint together, fixed with 1-in (25-mm) galvanized or alloy screws.

2Replace post • If a fence post wobbles, it is rotten

at the base and needs replacing.

• Detach the fencing on either side.If the fence is closeboarded, wedgestrong wood props under the topedge to hold the fence in placewhile you work on the post.

• For a post set in concrete, cut itoff at ground level, drive a metalrepair socket into the centre of thestump, then insert a new post cutto the right length. Reattach thefencing panels on either side.

• For a post not set in concrete, dig itout and replace it with a new one.

• Before inserting the new post, soakit in chemical preserver overnightto protect it against rot.

• Anchor the new post firmly intothe ground then reattach thefencing panels on either side.

Replace panel• If a fence panel has been damaged

by an impact, blown over by highwinds, or is in a state of disrepair,you will need to replace it.

• For a panel supported by woodenposts or recessed concrete posts,remove the nails or angle bracketsholding the panel in place at eachend and remove the panel. Hold anew panel in place and reattach it.

• For a panel supported by groovedconcrete posts, slide the old panelout and slide a new one in.

Slot the fencepanel into thegroovedconcrete post

Reattach the hingeswith stronger screws


LEAKING ROOF

1Inspect the roof• Look at your roof from the ground,

using binoculars if necessary, tosee if you can spot any slipped ormissing tiles or slates.

• Go to the loft with a flashlight andinspect the roof from the inside.

• If the roof is lined, check the liningfor damp stains.

• If the roof is unlined, look for raysof daylight between tiles.

• Check roof timbers for dampness.

• If the source of the leak is at ajunction between the roof andother parts of the building, suchas a wall or chimney, inspect themetal strips (flashing) that sealthe join from the outside.

• Once you have identified the sourceof the leak, make a temporaryrepair from inside (see box) if youcan. Then call a roofing contractorto make a permanent repair.

2

3Install newtile or slate• Slide the new tile or slate into

place on a builder’s trowel until thetwo nibs on the back of the tile orslate hook on to the roof battens.

• Remove the wedges that werepropping up the surroundingtiles or slates.

4Repair flashing• If flashing has deteriorated, it needs

to be replaced by a roofing contrac-tor. Cracks or shrinkage, however,can be repaired relatively easily.

• If the edge of the flashing has comeaway from the wall, push it backinto the mortar course and applynew mortar to secure it.

• If the flashing is cracked, coverit with aluminum self-adhesiveflashing tape, following themanufacturer’s instructions.

TEMPORARY ROOF REPAIR

Use the lower edge of theplastic sheet to drain

water away from the roof

Push the plastic underthe damaged area

Secure sheetingPush the lower edge ofthe plastic out over thelower edge of the hole, sothat it directs water downthe roof. Secure it withstrong waterproof tape.

Patch the holeCut a sheet of strongplastic, at least 12 in(30 cm) larger than thehole. Slide it betweenthe roof battens andthe tiles surrounding themissing or damaged tile.

Remove tiles/slates• Wedge up the tiles or slates that

overlap the damaged one, then rockit loose and slide it out carefully.

• Buy a matching tile or slate fromyour local construction store.


LEAKING GUTTERS AND LEADERS

1

2

Check guttersand pipes• If rainwater is overflowing from

the gutter, check both the gutterand the leader leading fromit for blockages. Obstructions arecommonly caused by a build-upof leaves, birds’ nests or ballsfalling into leaders.

• If water is leaking through thegutter, check the dripping areaof the gutter for cracks, holes,or bad joints.

• If the gutter is not damaged, checkto see if it is sagging, whichprevents it from draining properly.

Clear blockages• Put on protective gloves, and clear

the gutter of leaves and debris sothat water can flow freely.

• Clear both ends of the leader.

• If the blockage is caused by a bird’snest, make a hook out of a lengthof stiff galvanized wire. Slide thewire down one side of the nest tohook it up and out of the pipe.

• For a blockage that is out of reach,use a long, flexible rod to clear it.

Good maintenance• If leaves are a nuisance, secure protective

mesh over the gutter and in the mouthof the leader. You will need to ensurethat there is no build-up of leaves overthe mesh, as this could cause rainwaterto pour over the edge of the gutter.

• Repaint metal drains and guttersfrequently to prevent them from rustingand developing holes or cracks.

!

3Repair faultygutter• If the gutter is plastic, seal a

leaking joint by wrapping gutterrepair tape around it. If the gutteris cracked, place tape over thecrack inside the gutter.

• Repair asagging guttertemporarily byhammering awooden wedgein between thegutter and eachbracket to holdeach sectionin place.

• If the gutter is metal, scrape offany rust, then paint the leakingarea with a sealing compound.Protect the repair until the sealanthas dried, then repaint.

• To treat holes in metal gutters,first put on safety goggles, thenwire-brush away any loose rust.

• Apply a rust-proof primer, thenseal small holes with a sealingcompound and large holes with aspecial glass-fiber filler. To finish,apply tar or gloss paint.

208

COCKROACHES


1 Identify source• Fleas are usually brought into the

house by the family pet. Makesure that all pets are regularlytreated with flea killer.

• Flea eggs can lie dormant incarpets until they are activatedby movement or warmth.

2Apply flea killer• Buy a flea repellent/insecticide,

preferably from a veterinary office.

• Vacuum carpets, then spray carpetsand furnishings with flea killer,especially under sofas and beds.

• Treat your pets and wash theirbedding regularly.

1Use insecticide • If you can find where cockroaches

are hiding, spray the area well withan insecticide.

• If the cockroaches persist, contactan exterminator.

2Repeat treatment • New cockroaches are likely to

appear at 4-monthly intervals; beprepared to repeat the treatment.

• Keep work surfaces clean andclear of any food.

ANTS

1Use insecticide • Sprinkle ant insecticide powder

into the nest entrance or whereants are enteringthe house.

2Use gelatin bait • If the insecticide is ineffective, put

down poisoned gelatin bait; thiswill be taken backto the nest, killingthe other ants.

FLEAS

As well as being a nuisance, insects can sting or bite; cockroaches, mice, andrats create unhygienic conditions; and woodworm can ruin woodwork. Takesteps to eliminate insects or pests or call an exterminator.

Insects and pests

Sprinkle ant powderinto any crackswhere ants appear

209

MICE AND RATS

BEES, WASPS, AND HORNETS

INSECTS AND PESTS

1 Block entry holes• Small pellet-shaped droppings in

your home indicate mice.

• Look for any obvious entry holesinto your home and block them.

3Set traps • Set three or four baited mouse

traps where droppings are found in the house.

• Use peanut butter, chocolate, orcooked bacon as bait for traps.

2Put down bait• Put down poisoned mouse bait

wherever you find droppings. Beprepared to repeat if necessary.

4Call rodent control• Larger droppings indicate rats; call

your local health department.

1 Stay safe• If you see a swarm of bees close to

your house, get everybody insideand shut all doors and windows.

• Contact an exterminator.

3Treat stings• Try not to antagonize bees, wasps,

or hornets by spraying them withinsecticide; they are more likelyto sting you if they are angry.

• If you are stung, refer to p.59for treatment. Bee stingers can beremoved, but wasps do not leavea stinger. If you develop a minorallergic reaction, seek medical help.

• If you develop symptoms ofanaphylactic shock (p.28), seekmedical help immediately.

2Have nest sprayed• If wasps or hornets bother you

often, there is probably a nest.

• Contact an exterminator to deal with the nest.

WOODWORM

1 Identify signs • If you spot 1⁄16-in (2-mm) holes in

furniture or structural timbers,you have woodworm. Sawdust isa sign that woodworm are active.

• Minor woodworm attacks areeasy to treat (see step 2), but ifan infestation is severe, youshould seek professional help.

2Treat infestation • Brush surfaces with woodworm

fluid. On furniture, use an aerosolwith a nozzle to inject the fluid.

• To treat structural timberseffectively, use a large sprayer.

• To treat flooring, lift every thirdor fourth floorboard and spraythoroughly underneath.

210

GREASE ON CARPETS

1 Absorb grease • Place a piece of brown paper over

the mark. Put the tip of a warmiron onto the paper and press ituntil the grease is absorbed intothe brown paper.

2


Use carpet cleaner • To remove the remainder of the

mark, rub carpet cleaner gentlyinto the carpet with a sponge.

• If you have not used the cleaner ona particular carpet before, checkfor color fastness first by testingthe cleaner on an unobtrusive area of the carpet.

• Wipe off the foam with a cleansponge or cloth and inspect themark. If you can still see a stain, or the stain reappears later, repeatthe stain removal treatment.

GREASE ON UPHOLSTERY

1 Apply talcumpowder• Sprinkle a thick layer of talcum

powder over the mark, coveringit completely, and leave until thegrease begins to be absorbed.

2Brush off talcumpowder• After 10 minutes, brush off the

talcum powder.

• Repeat if necessary.

When accidents happen, it pays to clean up spills and stains quickly in orderto avoid lasting damage to upholstered furniture and furnishings, especiallycarpets. Equip your home with a basic stain removal kit (see below) and youwill be well-prepared to effectively tackle even the most stubborn stains.

Furniture and furnishings

ESSENTIALS

• Brown paper

• Talcum powder

• White kitchentowels

• Carpet cleaner

• Upholstery cleaner

• Ammonia

• Sponge

• Aerosol greaseremover

STAIN REMOVAL KIT

Cover greasewith talcumpowder

211FURNITURE AND FURNISHINGS

GREASE ON WALLPAPER

1 Blot grease• Use white kitchen towels to blot

the splash, working quickly sothat the grease is not absorbed.

• Hold a piece of brown paper orwallpaper against the stain.

2Use iron• Warm an iron, switch it off, then

press it onto the covering paper to draw out the grease.

• Use an aerosol grease remover onany remaining traces.

RED WINE ON CARPETS

1 Flush spill• Blot the spill immediately with

white kitchen towels then spongeit with warm water to flush outthe stain. Pat the area dry.

• Alternatively, pour white wine onto the spill, blot up both liquids,then sponge with clear, warmwater and pat dry.

2Clean stain• Apply carpet cleaner. Work some

of the foam into the stain with asponge, always rubbing from theedge of the stain inwards toprevent it spreading.

• Sponge the stain with clear waterto rinse it. Repeat the treatmentuntil the stain has disappeared.

1 Remove droppings• Wear rubber gloves.

• Remove the dropping with aspoon, always scraping into thestain to avoid spreading it.

• Pour a few drops of ammonia intowarm water and use the mixtureto sponge the stain clean. Repeatthe treatment if necessary.

2Remove urine• Clean the stain from a carpet or

upholstery using a cleaner thatcontains a deodorant.

• Alternatively, sponge the stainwith cold water and pat dry.Follow this by sponging thestain again with cold watercontaining a little antiseptic.

Rub the foam gently intothe stained area

PET STAINS ON CARPETS AND UPHOLSTERY

Flood the red wine stainwith white wine

4 Install windowsecurity devices• Windows are popular points of

entry for burglars.

• Secure windows with locks ordeadbolts to prevent the catchesbeing released through a smashedwindow. There are several typesfor metal and wood windows.

5Assess lighting• If you install security lighting to

help you unlock your door on darknights, remember that this couldbe equally useful to a burglar.

Consider an alarm• For the best security, either install

a burglar alarm yourself or haveone installed professionally.

212

By identifying vulnerable areas of your home and taking adequate precautions,you can dramatically reduce the risk of being burglarized. Installing additionallocks and bolts is an effective way of deterring thieves. Security devices such aspeepholes, door chains, and alarms are also easy to install; and they not onlysafeguard your property but also provide peace of mind, particularly when youare away from home.

Home security

ASSESSING YOUR HOME SECURITY

1 Identifyvulnerable areas• Check all your doors and windows

for strength and security. Imaginethat you have locked yourself out:which window or door would youchoose to force open or break?

• Look at your house again andreassess your security.

• Contact your local policedepartment for advice.

3Install patio doorlocks• Install locks and deadbolts (p.214)

at the top and bottom of patiodoors and French windowsto prevent them from beingforced open.

2 Install main doorsecurity devices• Install locks on the front, back, and

any side doors. For added security,you should install heavy bolts atthe top and bottom of the insideof each door.

• Back and side doors must havesturdy locks because they are oftenhidden from view and badly lit,which means that a burglar canattempt entry unobserved.

• For security when answering thedoor, install a strong door chainand peephole (p.213).

• If a door opens outward, installhinge bolts to the back edge(p.214) so that the door cannot belevered open on the hinge side.

6


213

INSTALLING A DOOR CHAIN

SELECTING LOCKS

1Choose chain• Choose a strong door chain and

the longest and heaviest-gaugescrews possible. Thechain’s strengthdepends upon howwell it is anchored tothe door and frame.

1Check for quality• Always invest in high-quality

locks. Cheap locks are more likelyto rust and stick, which meansthat they are not cost-effectivein the long term.

2Use strongfasteners• If you install locks on your doors

and windows, use long, strongscrews for maximum strength.

• If you are unsure, get a locksmithto do the job for you.

2Attach plates• Hold the chain against the door,

ideally just below the lock.

• Make pilot holeswith a bradawlor drill so thatboth sections ofthe chain arealigned, thensecure bothfixing plates.

Screw the fixing platesto the door and frame

1Select viewer• Choose a telescopic viewer with as

wide an angle of vision as possible.You should be able to see someonestanding to the side of thedoor or even crouching down.

• Before you buy the peephole,make sure that the viewer isadjustable to fit any door.

• Mark the best position forthe peephole, ideally in thecenter of the door at eye level.

2Fit peephole • Using the correct-sized drill bit,

usually 1⁄2 in (12 mm), drill a holeright through the door.

• Insert the barrel of theviewer into the holefrom the outside andscrew on the eyepiecefrom the inside.

• Check that the lightingoutside your frontdoor is bright enoughfor you to be ableto see out clearlyat night.

INSTALLING A PEEPHOLE

Drill the hole for thepeephole at eye level

HOME SECURITY


INSTALLING HINGE BOLTS

1Position bolts • Wedge the door fully open and

mark the center of the hinge edgeof the door about 3 in (75 mm) in from both hinges.

• Drill holes at the marked points tothe width and depth specified by themanufacturer.

• Fit the bolts into theholes and partiallyclose the door sothat the bolts markthe door frame.

2Install cover plates• At the marked points, drill holes

into the door frame to the widthand depth of the protruding bolts,allowing a little more for clearance.

• Close the door to check that it shutseasily. Enlarge the width or depth

of the holes as necessary.

• Open the door and holdcover plates over the holes.Mark the edge of eachplate with a pencil.

• Chisel out the recesses sothat the plates lie flushwith the cover frame.

• Screw the plates in place.

INSTALLING A DEADBOLT

1Drill holes for thebarrel and key • Mark a central point on the front

edge of the door where you wantto install the bolt.

• Drill a hole at the marked point tothe width and depth given on themanufacturer’s instructions.

• Use a square to mark a linetransferring the center of the holeto the inside face of the door.

• Mark the keyhole, then drill a hole(see manufacturer’s instructionsfor width and depth) through theinside face of the door only.

2

Insert the bolts into the drilled holes

Drill into theopening edge of the door Mark the

shape of thefaceplaterecess

Install bolt and plate• Screw the keyhole plate to the door.

• Insert the bolt into the hole. Thendraw around the faceplate to markits recess. Gain the wood with achisel. Screw the bolt to the door.

• Insert the key and turn the bolt tomark the door frame. Then drill ahole to a depth that matches thelength of the bolt.

• Fit the escutcheon over the hole.

HOME SECURITY 215

JAMMED LOCK

JAMMED CYLINDER LOCK

DAMAGED MORTISE LOCK

1Add lubricant• If a lock is jammed, do not try to

force the key to turn: you couldbreak the key in the lock.

• Apply a few drops of penetratingoil to the key, or dry lubricant,such as graphite powder, to thelock, to ease the problem.

1Replace strikerplate• If a striker plate is damaged,

causing a door to stick as it closes,buy a replacement.

• Unscrew the damaged striker platefrom its position in the door jamb.

• Insert a replacement striker platein exactly the same position andscrew it into place.

2Replace lock body• If a mortise lock is jammed (see

above) or if you are worried aboutthe security of your existing lock,replace the lock body.

• Unscrew the lock body and removeit from its mortise in the door.

• Insert a replacement lock body intothe mortise and screw it into place.If the fit is too tight, use a woodchisel to enlarge the recess slightly.

2Install new cylinder• Insert a new cylinder by sliding it

into the cylinder hole and screwingit into place.

• Put the lock body back in positionand refix the holding screws.

1Remove cylinder• If a cylinder lock is jammed (see

above) or if you are worried aboutthe security of your existing lock,replace the cylinder.

• Unscrew the lock body on theinternal side of the door, thenunscrew the cylinder.

• Remove the cylinder from itscavity by pulling it from theexternal side of the door.

2Work key• Work the key gently in and out

of the lock, adding a little morelubricant if necessary.

• If this fails, either replace thecylinder if it is a cylinder lock (seebelow) or replace the lock body ofa mortise lock (see below).

Slide the new cylinderinto the existingcylinder hole

216

DEALING WITH INTRUDERS

2Make a noise• If you do enter your home and meet

an intruder, run out and shout orscream as loudly as you can.

• Don’t try to apprehend him or her.

3Stay calm• If you must face the intruder, keep

calm and try not to provoke areaction by making threats.

• Try to memorize as much as youcan of the intruder’s appearance,mannerisms, and speech so thatyou can provide the police withan accurate description.

4Call the police• Dial 911 or call your local police

station.

• Try to give the police as muchinformation as possible.


• If you are woken in the night by unusualnoises or the sound of breaking glass,call the police.

• Keep your cellular phone turned on bythe bed so that you can still call for helpif the telephone line has been cut.

• If you are alone in the house, talk loudlyas if you have a companion in the room.You could also switch on the lights andmake a lot of noise. Most intruders willleave as soon as they hear noise.

• Do not go downstairs to investigate.

• Do not keep an offensive weapon or try to defend your property. No items,however valuable, are worth seriousinjury or death.

• If you meet the intruder, stay calm andtry to memorize his or her appearance.

1Be vigilant• If you arrive home and see anyone

loitering outside, pass by yourhouse and ask a neighbor toaccompany you to the door.

• If you return home to find thatthe front door is open, do notenter your home. Move a safedistance away and, if you havea cellular phone, call the police. Alternatively, go to a neighbor’sand phone the police from there.

• If you come home and your keywon’t open the door, it could meanthat an intruder has secured thedoor from inside so as not to bedisturbed. Move away quicklyand call the police.

• If you return home to find thatyour home has been ransacked,call the police immediately. Donot touch anything until the policearrive so as not to destroy anyfingerprints left by burglars.

Responding to a disturbanceWhen you dial 911, you will be advised on whetherto make a noise or to pretend that you are asleep.Stay in bed until the police arrive.

DEALING WITH A NIGHT INTRUDER

217

COPING AFTER A BREAK-IN

HOME SECURITY

1Don’t moveanything• If you discover that your home has

been broken into, try to keep calm.

• Do not touch anything. The policewill want to check the crime sceneand look for fingerprints.

4 Secure premises • If burglars have forced entry by

smashing glass, make a temporaryrepair for security (p.200).

• Determine how the burglar(s)gained access to your home andtake steps to make it more secureby installing additional locks orbolts (p.214).

5Contact insurers• Contact your insurance company

and explain what has happened.

• The insurance company and/orclaims adjuster will require thecomplaint number and a detailedlist of what has been stolen.

6Keep in contactwith police• If you move while the investigation

is still ongoing, notify the police ofyour new address.

• If you discover more damage ormissing items, contact the officerhandling your case as well as yourinsurance company.

2Call police• Dial 911 or call your local police

station.

• When the police arrive, they willtalk to you about the burglary, askwhat has been taken, then take astatement. They will then provideyou with a complaint number foryour insurance company.

3List missing items• Start to make a list of what you

think has been taken. This processcan go on for days, because manyitems will be missed only whenyou try to find or use them. Thepolice should supply you with aform for your list.

• Give as clear a description asyou can of all items, and providephotographs of valuables, if youhave any.

• Indicate on the list which, if any,items have been owner-labeled.

SEEKING ADVICE

• If you are the victim of a burglary orassault, you will be contacted by VictimSupport, an organization that providescounselling and help for victims of crime.

• Talk to friends and family about yourexperience. They may be able to offeryou reassurance and comfort.

Give your insurancecompany details ofwhat has beenstolen

Surviving any kind of natural disaster depends largely on beingprepared. If you know how to protect your home and family, how tounderstand the early warnings, and how to evacuate if advised to do

so, you will be ready for most disaster situations. Once a disasteris over, life may not return to normal for some time, so you also

need to know how to cope with the consequences, including powercuts, damage to your home, and water shortages. If evacuated, you

may even have to survive outside for a while before help arrives.

4

NATURALDISASTERS

Planning for disaster.........................220Severe storm................226Flood ............................228Extreme cold................230

Wildfire.....................232Hurricane.............234

Tornado .......................236

Earthquake ..................238

Volcanic eruption.......................240

Tsunami........................242

Post-disaster survival.........................244

220

If you live in an area that is prone to certain types of natural disaster, planningand preparing for an emergency will help protect you and your family. Takesteps to safeguard your home and property. Choose a safe place indoors totake shelter. If hurricanes are a threat, find out where your local shelter is,and assemble essential equipment that may help you survive the aftermath.

Planning for disasterNATURAL DISASTERS

ACTION PLAN

ACTION

PREPARE A KIT FORTHE TYPE OF DISASTERYOUR AREA FACES.

ACTION

PROTECT YOUR FAMILY.

ACTION

CONTACT YOURCITY/TOWN COUNCIL.

Yes

No

Do you knowif any disasters

are likely(p.221)?

Yes

No

Have youprotected

your property(p.222)?

START

Yes

No

Do youhave a disasteremergency kit

(pp.224–5)?

Yes

No

Do you have anevacuation plan

(p.224)?

No

Yes

Have yousought

information onthe disaster(s)?

No

Yes

Have youprotected

your family(p.223)?

ACTION

MAKE SURE YOU ANDYOUR FAMILY KNOWWHAT TO DO.

ACTION

PROTECT YOURPROPERTY.

ACTION

CHECK AND REPLENISHSUPPLIES REGULARLY.

221

1 2

ASSESSING YOUR RISK

PLANNING FOR DISASTER

Be informed• Contact your town/city council to

find out whether your area is proneto any specific types of disaster. Askfor information about each type.

• If your area is prone to flooding,contact your city/town council tofind the height to which a floodcould rise.

• Before moving or traveling abroad,find out about potential disasterrisks in that area.

• Learn about the effects of disastersthat may strike your area.

• Volcanic eruptions and earthquakesoccur around geological fault lines;both can produce tsunamis.

• Hurricanes mostly affect areasaround the Atlantic basin and thePacific basin, where they are knownas tropical cyclones. They are oftenaccompanied by tornadoes.

• Flooding can occur almost anywhere,although the most serious floods areusually caused by very high tides.

• Wildfires occur in many countries –80 percent are started by humans.

• Extreme cold occurs in much of theNorthern Hemisphere but manycountries experience freezes in winter.

Reduce risk• Take steps now to protect your

property against natural disasters.Your home will be less vulnerableif you take sensible precautionsand carry out routine buildingmaintenance (p.222).

• Protect your family by coming upwith a family disaster plan (p.223)and making sure that you are allprepared for evacuation (p.224).

• Always keep abreast of the weathersituation and local plans regardingshelters and evacuation.

High risk of seismicactivity (volcaniceruptions, earthquakes,tsunamis)

High risk of severeclimatic conditions(hurricanes, tornadoes,coastal flooding)

Areas at risk ofextreme cold

Tectonic plates

222

PROTECTING YOUR HOME

PROTECTING YOUR YARD

• Have unsafe or old chimney stacksremoved or repointed.

• Replace cracked or broken slatesor tiles on the roof (p.206). Checkthat roof flashings are watertight.If any are loose or damaged, havethem repaired or replaced (p.206).

• Keep gutters and leaders clear andin good repair (p.207).

• If you live in an area prone totornadoes or hurricanes, installspecial hurricane shutters.

• Alternatively, install wooden frameson the windows so that you canboard them up quickly (p.234).

• Check and, if necessary, repair anyobvious weaknesses, such as cracksthat are wider than 1⁄8 in (3 mm),in the structure of your house.

• If your area is at risk of flooding,make sure that you have sufficientsandbags to block all potentialwater entry points, such as externaldoors and vents (p.228).

• Ensure that all adults in thehome know how to turn off gas,electricity, and water at the main,in case you need to do so quickly.

• Check that you have adequateinsurance coverage for damagecaused by local disasters.

PROTECTING YOUR POSSESSIONS

• Make sure that shelves are securelyfastened to the wall.

• Keep heavier items on lowershelves so that if a disaster occursand they fall, they are less likelyto injure anyone.

• If flooding is a risk in your area,keep precious items on highershelves to protect them from waterdamage. Alternatively, move yourmost valuable possessions upstairs.

• Bolt tall pieces of furniture,boilers, and other heavy items tothe wall or floor (p.238) to ensurethat they are stable and secure.

• Install additional devices to secureheavy light fixtures to ceilings.

• Keep a supply of bricks that youcan use to raise heavy furnitureout of reach of flood water.

• Keep a fire extinguisher and blanketto put out minor house fires.

• Remove any diseased or broken treebranches that could be blown aboutby high winds. Thin out crowdedbranches to reduce wind resistance.

• If you live in an area that is proneto wildfire, create a safety zonearound your home (p.232).

• During hurricane/tornado seasons,bring indoors or move into thegarage any garden furniture orchildren’s play equipment thatis not anchored to the ground.

NATURAL DISASTERS

Cut off any broken branchesbefore high winds rip them off

223

PROTECTING YOUR FAMILY

1Be informed• Contact your city/town council to

find out if warning signals will beissued and what action you shouldtake (see box below) in a disaster.

• If you live in an area that is proneto certain disasters, you may begiven a telephone number to callfor up-to-date information andwarnings. You may also find adviceon the Internet (see pp.250–251for recommended websites).

• Prior to a disaster, public addresssystems such as bulhorns may beused to inform people quickly andprovide instructions.

• If you are likely to be evacuatedto an emergency shelter, find outbeforehand where the nearestshelters are and how to get to them.

2Think ahead• Keep emergency contact numbers

near the telephone and ensure thateveryone knows where they are.

• Consider how to help the elderlyand physically disabled.

• Plan how you are going to lookafter pets. Keep pet carriers forsmall family pets if necessary.

• Assemble essential items that youwill need if disaster strikes (p.225).

3Make a familydisaster plan• Discuss how to prepare for disaster.

• Make sure that any childrenunderstand the dangers of severeweather and other disasters thatthreaten your area.

• Some natural disasters, includinglightning strikes, earthquakes, andvolcanic eruptions, can cause housefires. Have a meeting place justoutside the home where you cancheck that everyone is safely out ofthe building in the event of a fire.

• Arrange a second meeting placesome distance away, such as at afriend’s or relative’s home, shouldyou have to leave the immediatearea. Make sure that everyone hasthe address and telephone number.

• Choose at least two escape routesfrom your home and each room.

• Identify safe places in your homewhere you could take shelter ifyou are advised to stay indoors orif you do not have time to leavebefore a disaster strikes.

• Make a family evacuation plan(p.224).

• Discuss how to make contact andreunite family members should adisaster occur when you are notall at home together.

UNDERSTANDING EARLY WARNINGS

• If you live in a hurricane or tornado zone, beprepared for a “watch” (indicates possibledisaster) and then a “warning” (indicatesprobable or imminent disaster) as thehurricane or tornado approaches your area.

• If you live in a tsunami area, an “advisory” isthe first alert, followed by a “watch” (possible)and “warning” (imminent).

• If you live in an area prone to flooding,a “watch” (possible) may be followed by a“warning” (imminent) and then a “severewarning” (imminent and severe).

• In areas of particular risk, there may be asystem for sending warning messages bytelephone, fax, or pager directly to peoplewhose homes are threatened.


224

EVACUATING SAFELY

1 Follow instructions• Prepare to evacuate if you are told

to do so by your city/town councilor emergency services, or if youfeel in danger in your own home.

• Follow evacuation instructionscarefully: there may be limits onwhat you can take with you.

2Consider extras• If your area is at risk of a major

disaster, you may well have tosurvive outside for several days.Plan to take water-purifying tablets.Have garbage bags and a plasticbucket with a lid (to be used as atoilet) and rolls of toilet paper.

• If you live near a volcano, add adisposable dust mask and gogglesfor each family member.

• If you have a small pet, keep apet carrier.

3Take precautions• If high winds are forecasted, bring

children’s play equipment andgarden furniture indoors (p.222).

• Call the friend/relative whose homeserves as your second point ofcontact in your evacuation plan.Explain where you are going.

• Use telephones and cellular phonesonly if it is essential to get in touchwith family or friends; otherwise,keep lines free for emergency calls.

• Always turn off the gas, electricity,and water before leaving.

• Close and lock all your externaldoors and windows as you leave,including doors to outbuildings.

4Be a goodneighbor• Make sure that your neighbors are

aware of the need to evacuate.

• Help elderly or disabled neighborswho may be unable to evacuatewithout your assistance.

2Gather familymembers• Assemble family members quickly,

collect your disaster emergency kit(p.225), and decide whether youshould leave by car or go on foot.

• Help the elderly and childrenevacuate. Leaving home in adisaster situation is distressing, soremain calm and be reassuring.Older people might requireparticular help, such as the aidof a wheelchair.

• Put small pets into pet carriers;take dogs with you in the car or putthem on leashes if you are on foot.

1Organize basicitems• List the items you would need to

take with you in an evacuation (seep.225 for suggestions).

• The amount of equipment you willneed depends on the type and extentof disaster likely to affect your area.

• Assemble these items.

• Encourage your children to helpwith the planning and packing ofyour family emergency kit.

PREPARING A DISASTER EMERGENCY KIT

NATURAL DISASTERS

225

3Keep kit ready• Keep your disaster emergency kit

in a safe, accessible place, such asin the garage, and ensure that allfamily members know where it is.

• Practice evacuating your home;loading the kit into the car, andleaving as quickly as possible.

• Replace your water supplies every6 months and regularly check thesell-by dates of all foods.

• Test batteries regularly.

• Note the expiration dates of first-aid and prescription medicines.Replace those that have expired.

4Assess situation• If evacuating by car, load your kit

into the trunk.

• If evacuating on foot, decide howmuch of the kit your family cancarry.

• In the case of a mass evacuation,emergency shelter will be providedin local community buildings. Insuch situations you do not need totake food, water, or bedding.

• In situations where it may be sometime before you can return home,take plenty of clothing and toys orgames to keep children busy.

DISASTER EMERGENCY KIT

WATERStore 8 pints (4.5 liters)

of water per personper day

BATTERY-POWEREDRADIO

Use this for news of thedisaster and emergency

radio broadcasts

MEDICAL EQUIPMENTPack a first-aid kit andany over-the-counter

or prescriptionmedicines needed

FAMILY DOCUMENTSKeep passports and

family documents in awaterproof wallet with

emergency money

BABY FOOD AND MILKTake jars, cans, formula

mixes, bottles andspoons

DIAPERS AND CREAMSKeep supplies of

disposable diapers anddiaper cream

RAINWEARHave a lightweight,

waterproof jacket foreach family member

SHOES AND CLOTHESKeep a change of

footwear and clothingfor each person

FOOD ANDCAN OPENER

Store enough cannedor dried food for

3 days

BEDDINGKeep one sleeping bagor blanket per personfor sleeping outside

FLASHLIGHTS ANDBATTERIES

Have one flashlight perfamily member, plus

plenty of spare batteries


CANDLES ANDMATCHES

These are for backuplighting during a

prolonged poweroutage

226

COPING WITH A SEVERE STORM

For FLOOD see p.228High winds during a severe storm can cause damage to roofing, chimneys, andwindows, while heavy rain can cause leakage and flooding. Lightning can alsobe dangerous if you are out in the open. But there are steps you can take to copewith and protect against storms and lasting damage.

Severe stormNATURAL DISASTERS

1Take precautions• Stay inside during the storm.

• Fasten doors and windows tightlyand check that doors to gardensheds and garages are also secure.

• Keep flashlights, candles, andmatches in case of power outages.

• If a thunderstorm is on the way,disconnect television antennaeand unplug computers andtelevisions. Power surges fromlightning can start fires and causeconsiderable damage.

• Keep some buckets that you canplace under ceiling leaks if the roofis damaged.

• Store garden furniture.

3Minimize damage• If a window is blown in, move

valuables out of that room. Blockthe window with boarding, nailingit from the inside. Alternatively,move a large piece of furniture,such as a wardrobe, in front of it.

• If a chimney stack is blown off,water may find its way down thechimney. Use boards to block allfireplaces, preventing rubble fromcoming down into the room.

2Deal with leaks• Water dripping through the ceiling

indicates that the roof is damagedor that flashing has worked loose,allowing water to seep through.

• Place buckets under the drips andgo into the attic to look for a leak.

• If a roof tile or slate is damaged ormissing, make a temporary repairwith plastic sheeting (p.206).

• If water is coming in around thechimney stack, repair or replaceflashing after the storm (p.206).

• If water is pooling outside yourhouse, use a stiff broom to sweepit away, preferably downhill.

• If the water continues to rise, blockall gaps under and around doorswith sandbags (p.228).

Take inside anythingthat could be damagedby the storm

2Protect yourself• Do not carry anything with a metal

rod, such as an umbrella or golfclub, that might conduct lightning.

• If you feel your hair stand on end,lightning is about to strike.

• If you are near trees or rocks, runfor open ground, if you have time.Kneel down, bend forward toprotect your head, and put yourhands on your knees.

• It is important to protectyour head, the mostvulnerable part of thebody, and to minimizecontact with the ground.

1Get to safety• If you are out in a lightning storm,

seek shelter in a low area, such asa ditch or hillside, away from talltrees and poles, and water.

• Remember that any thunderstormmay produce lightning.

• Stay far away from metal objects,such as fences or pylons, whichpose a particular danger: lightningsparks can arc off metal, andstrike anyone standing nearby.

• If you are riding a bicycle, get off,leave the bicycle, and take shelter.

• If you are riding a horse, get off,tether the horse safely to whateveris available, then seek shelter.

• If you are in a car with a metalroof, stay where you are: the car’smetal shell and rubber wheels willprotect you.

• If you are out in a boat, head forland immediately.

227

BEING OUTSIDE IN LIGHTNING

SEVERE STORM

DO’S AND DON’TS

DO• Get to open land.

• Stay away from talltrees or rocks.

• Get as small and lowyou can.

• Protect your headfrom a possible strike.

• Stay in your car ifyou can.

DON’T• Stand on high ground,

such as on top of a hill.

• Think that you areprotected by wearingrubber-soled shoesor boots.

• Kneel or sit down onwet material.

• Carry metal objects.

Keep your headlower than therest of your body

!• A bolt of lightning can be fatal if it strikes

someone on the head and then travels downto the ground. It can also cause severe burns,broken bones, cuts, and unconsciousness; andit can set clothing on fire.

• Do not touch someone who has been struckby lightning if he or she is very wet or inwater: you could be electrocuted becausethe electrical discharge is still within his orher body.

• Dial 911 or call EMS immediately, even if theperson appears to be unharmed.

• If the person’s clothing is on fire, followthe instructions on p.182.

• Treat the burns (pp.48–9).

• If the person is not breathing, start rescuebreathing (pp.16–17).

• If the person has no signs of circulation, startCPR (pp.18–20).

If someone is struck by lightning

2

228

For SEVERE STORM see p.226 For TSUNAMI see p.242Heavy rainfall, melting snows, rivers changing course, dams collapsing, and hightides in coastal areas can all cause floods. If you live in an area prone to flooding,know the difference between a “flood watch” (flooding is possible), a “floodwarning” (flooding is expected), and a “severe flood warning” (severe floodingis expected). Take the necessary measures to protect your family and home.

Flood

PREPARING FOR A FLOOD

NATURAL DISASTERS

1Plan ahead• Contact your city/town council to

find out the height to which aflood could rise.

• Be alert to flood warnings issuedby weather forecasters and theEnvironmental Protection Agency.

• Keep enough bricks with whichto raise wooden or upholsteredfurniture off the floor and out of the flood water.

• Buy sandbags and sand if water islikely to rise above door level.

• Keep your important documents inplastic wallets in a safe place.

Using sandbagsLay the second row of bags in place, staggering thebags over the first row in a brickworklike formation.

• Use sandbags to seal entry points around doors andvents. Also seal windows if the water is likely to risethat high.

• Half-fill the sandbag casings with sand. If you run outof casings, make your own from plastic shoppingbags, pillow cases, or even stockings.

• Place the first row of bags in position, butting themup against each other, end to end, and then stompdown on them to mould the ends together.

• Lay the second row on top, staggering the bags, andstomping down on them to mould them into the rowbelow. This will prevent seepage through gaps.

• If your wall of sandbags needs to be three or fourlayers, lay two rows side by side, followed by a seconddouble row, then one or more single rows on top.

PROTECTING YOUR HOME WITH SANDBAGS

Prepare home• Block all gaps under and around

external doors with sandbags (seebox below).

• If flood water is expected to riseup to window height, placesandbags along windowsills too.

• Take up your carpets and storethem upstairs along with all thevaluables you can move.

• Fill clean baths, sinks, and plasticbottles with cold water.

• Turn off electricity and gas supplies;flooded wiring can cause fires.

• Use bricks to raise furniture.

229FLOOD

2Evacuation• If you are told to evacuate, follow

the instructions carefully.

• In addition to taking your disasteremergency kit (p.225), take all theclothing you can. It may be days or,in some situations, weeks beforeyou are able to return home.

3Signal for help• If the water has risen to the point

that you are unable to leave safelyon foot, or you feel that your lifeis in danger if you stay where youare, signal for help.

• Lean out of an upstairs windowor climb onto the roof and call forhelp by shouting and/or wavingsomething bright.

• Do not climbonto the roof if itis slippery or ifthere are highwinds: you mayput yourself ingreater danger.

1 Stay inside• If you can, move

upstairs, taking withyou food, water,emergency supplies,pets, valuables, andimportant papers.

• If flood water rises quickly,leaving you no time to moveyour valuables upstairs, putthem on high shelves tokeep them out of the water.

• Be aware that flood water canweaken structuralfoundations, causing buildingsto sink, floors to crack and, insevere cases, walls to collapse.Regularly check for cracks in whatyou can see of your walls, floors,doors, staircases, and windows.

• Listen to your radio for updatedlocal information and follow allofficial instructions.

• Observe outside water levels to seehow fast the flood is rising.

• Use your drinking water supplyuntil you are told that the mainwater is safe to drink.

SURVIVING A FLOOD

Attract attentionby shouting andwaving

!If you are outside• Be very careful when walking through flood

water: just 6 in (15 cm) of fast-flowing watercan unbalance you and cause you to fall.

• If possible, use a stick to feel the groundbefore you step on it: hazards hidden underthe water could be highly dangerous.

• Avoid riverbanks and sand dunes, whichcould collapse. Also beware of large waves.

• Minimize contact with flood water: it couldbe contaminated with sewage.

Take plentyof waterwith you

Take small petsupstairs in petcarriers

If your child isupset by the flood,carry her to safety

230

PREPARING FOR EXTREME COLD

Extreme cold

1Check insulation• Attach self-adhesive foam strips

around loose-fitting doors andwindows to prevent drafts.

• Fit draft protectors across thebottoms of external doors.

• Hang a heavy curtain at the frontdoor to keep the hall draft-free.

• To improve insulation, securesheets of glass in frames acrosssingle glazed windows. Alternatively,use a special heat-sensitive plasticfilm as a temporary measure (seebox right); the film is cheaper, butless efficient.

• Check that outdoor pipes andfaucets are properly insulated.

• Check that the attic, and pipesand water tanks within it, arewell insulated.

NATURAL DISASTERS

Heavy snowfall and very low temperatures can produce difficult conditionsboth in the home and outside, especially if cold weather is prolonged. Preparefor wintry conditions well in advance by checking in summer or early autumnthat your house is well-insulated. During a freeze, keep warm, stay safe, indoorsif you can, and be a good neighbor to the elderly or frail.

2

3Take precautions• Buy low-wattage electric heaters

that you can leave on overnight tokeep rooms above freezing.

• If you depend on electricity, buy aportable gas heater to use shouldpower lines come down.

• If you have a wood or coalfireplace, stock up on fueland matches.

• Maintain medicine supplies.

• If your stove is electric, stock upon foods that do not need cooking.

Check heating• Before winter arrives, turn on your

central heating to check that itworks. If you discover problemssee p.192 for advice.

• Stick aluminum foil sheets behindradiators to reflect heat back intothe room. This is particularlyimportant for radiators againstexternal walls.

TEMPORARY INSULATION

Keep the hairdryermoving to smooth film

Attach lengthsof tape

Stretch plasticPress heat-sensitive plasticfilm across the windowand onto the adhesivestrips. Hold a hairdryera few inches away andwarm the plastic untilthe film is quite taut.

Apply adhesive tapeAttach lengths of double-sided adhesive tape downthe sides and across thetop and bottom of thewindow. Allow adhesiveto harden for 1 hour.

2Stay inside• When outside conditions are icy,

do not venture outside unless needbe. If you must go out, see the boxon the right for sensible advice.

• Do not drive unless absolutelynecessary. If you will be driving onrural or hilly terrain, go preparedto be caught in a snowdrift orblizzard (see below).

• Check that you have a cold-weatherkit (see box right) in your car incase of emergency.

• Always take a cellular phone,whether you are on foot or in a car.

• If you live in an avalanche areaand an avalanche warning is issued,stay inside unless told to evacuate.

1 Stay warm• Keep the heating on day and night

at a low setting so that your homedoes not become cold and waterpipes do not freeze. Alternatively,use low-wattage electric heaters.

• If you are worried about costly fuelbills, heat only the rooms that youneed to use, and close the doorsto unheated rooms.

• Close the curtains to keep the heatin, but air rooms daily so that theydo not become stuffy.

231

SURVIVING EXTREME COLD

EXTREME COLD

IF YOU HAVE TO GO OUT

Preventing heat lossA hat is the most importantitem of clothing, becausemost body heat is lostthrough the head

• Dress warmly in layers of light clothing, ajacket or coat, hat, scarf, and gloves.

• Wear sturdy boots with deeptreads. Be careful to takesmall, firm steps; point yourtoes inward on downhillslopes and bend yourknees slightly if thegoing is steep.

• Be careful on icysurfaces; try to findsomething, such as arailing, to hold onto.

• Be particularly careful ifyou are elderly: brittlebones fracture easily.

Cover your handsand head

ESSENTIALS

• Shovel

• Blankets and coats

• Gravel or canvas

• Flashlight, batteries

• High-energy food

• Water

COLD-WEATHER CAR KIT

!If your car gets stuck in snow• Drive very slowly backward and forward,

moving only slightly each time, allowingyour car to gradually make a track for itself.

• If this does not work, use a shovel to clearaway snow from around the wheels, thenput down gravel or canvas to give the tiressomething to grip. Drive forward veryslowly. Once the car is clear of the snow,drive until you have reached safety.

• If you are unable to move the car, do nottry to walk to safety: stay inside the vehicle.

• Wrap yourself in blankets or newspaper.

• Turn on the engine and run the heater for10 minutes every hour to conserve gasoline.

• Open a window occasionally to let in air.

• Try to stay awake; the risk of hypothermia(p.54) is greater if you fall asleep.

232

PROTECTING AGAINST WILDFIRE

Most wildfires, which include bushfires and fires in woods, forests, and prairies,occur in hot, dry weather. These fires can spread rapidly, covering vast areas,and once they have taken hold, are very difficult to control. Protect your homeagainst wildfire by creating a safety zone, take sensible precautions to safeguardyour family, and know what to do in the event of wildfire.

Wildfire

SURVIVING WILDFIRE

NATURAL DISASTERS

1Create a safe zone• Remove all flammable vegetation,

dead branches, leaves, and twigs,and mow grass within 30 ft (9 m)of your home (100 ft/30 m if youlive in a pine forest).

• Keep this zone clear to ensure thatwildfires will have little to burnand pass by your house instead.

• Consider felling trees other thanfire-resistant hardwoods, such asoak, beech, or ash, inside the zone.

• Store flammable items, such as oldnewspapers, firewood, and woodengarden furniture, well outside thesafety zone.

2Be prepared• Make sure that gutters and drains

are clear of debris (p.207).

• Install a garden hose that is longenough to reach the full extent ofyour house and garden.

• Store in a handy, safe place tools,such as brushes and spades, thatcould be used to beat out fire.

• Plan several escape routes fromyour home by car and by foot.

• Arrange to stay elsewhere in caseyou have to evacuate the area.

• Keep plenty of fuel in your car sothat you can escape quickly in theevent of an emergency.

1Be ready toevacuate• If a wildfire appears to be heading

in your direction, check that yourcar has ample fuel, then park itfacing your main route of escape.

• Place your disaster emergency kit(p.225) in the trunk, then close allthe doors and windows and leaveyour key in the ignition.

• Assemble your pets and fire tools(see Be prepared, above).

2Protect your home• Bring wooden garden furniture

inside the house, if necessary.

• Use your garden hose to soak boththe safety zone and the house.

• Close all the windows, doors, andair vents. Draw heavy curtains, pulldown blinds, and take down anylightweight curtains.

• Move flammable furniture into thecenter of the house, away from anywindows and glass doors.

233WILDFIRE

3Get to safety • Keep the radio on and listen for

updated local information andofficial instructions.

• If you are told to evacuate, followthe instructions carefully.

• Put on a hat andgloves, strong shoes,and cotton or woolenclothing that coversyour arms and legs.

• Take your pets, disaster emergencykit, and fire tools with you.

• Choose a planned route that willtake you away from the fire, butbe alert to changes in the fire’sspeed and direction.

4Use your car asprotection• If you are overtaken by flames

when in the car, stay inside yourvehicle. You are safer inside yourcar than outside in the thick smokeand fierce heat, even with the riskthat the fuel tank may explode.

• Explain to any passengers the risksof leaving the car.

5Follow officialinstructions• Do not return home until you have

been given the all-clear.

• When you are allowed to returnhome, proceed with caution –small fires may still be blazing.

• As a precaution against more fires,resoak your house and the entiresafety zone with water.

• If your house has been damaged byfire, check with the fire departmentthat it is safe to enter the building.

• If necessary, arrange temporaryaccommodation elsewhere.

• If the fire has passed by your house,check for any smoke damage thatmay call for an insurance claim.Take photographs, if you can, tosupport future claims.

!If you are outside• Try to run diagonally away from the

fire to get out of its path. Aim foran open area; a road, or a river, ifpossible. If the fire comes close, laydown, curl into a ball, and cover yourhead, hands, and as much of yourbody as possible with a jacket.

• If your clothing catches fire, quicklysmother the flames with a coat andthen roll around on the ground toextinguish them (p.182).

Emergency actionIf fire is blocking all your escape routes,head for a dip or hollow and roll into a ball.

Take a brushto beat outsmall fires

Wear gloves toprotect your hands

Wear yoursturdiest shoes

2Take precautions• Keep alert for a “hurricane watch”

and listen to local radio stations forupdates on the situation.

• If a “hurricane watch” turns intoa “hurricane warning,” make finaladjustments to your home.

• Choose a safe part of the housewhere family members can gather,ideally in a room in the center ofthe house (such as a hallway) thatdoes not have windows.

• Close the hurricane shutters or fixboards in place (see box right).

• Secure external and garage doors.

• Fill clean baths, sinks, containers,and plastic bottles with water toensure an uncontaminated supply.

234

PREPARING FOR A HURRICANE

For FLOOD see p.228 For TORNADO see p.236Hurricanes are extremely violent storms that produce torrential rain and strongwinds of up to 190 mph (305 km/h). Tornadoes may occur simultaneously orin the hurricane’s wake. Flooding may also follow. Many hurricanes can bepredicted, enabling people to protect their homes and evacuate their families ingood time. If you live in an area that is prone to hurricanes, make sure that youknow the difference between a “hurricane watch” (a hurricane is possible within36 hours) and a “hurricane warning” (a hurricane is likely within 24 hours).

Hurricane

BOARDING WINDOWS

Align screw holes

Screw board in place

Predrill screw holes

Attach coverCut sheets of 1⁄2-in (1-cm)plywood to fit windowframe. Predrill holes toalign with the frame.Screw cover in place.

Make outer frameCut strips of wood to fitaround the outside of the window frame. Predrillwith holes 6 in (15 cm)apart. Nail the strips inplace to form a frame.

Secure framein place

1Plan ahead• Install hurricane shutters or buy

sheets of plywood and strips ofwood for boarding windows(see box below). Nail the framesin position and prepare theplywood sheets for installationwhen necessary.

• Know the location of the nearesthurricane shelter.

NATURAL DISASTERS

3Get to safety• If you live in a mobile home, leave

immediately and head toward ahurricane shelter or open ground.

• If you live in a house and you areadvised to evacuate, follow all theinstructions carefully.

• Avoid coastal and riverside roadson your way to a hurricane shelter:these routes may be flooded.

2Stay indoors• Do not evacuate unless advised

to do so, or you feel that it wouldendanger life to remain at home.

• Close all interior doors and placedoorstops under them.

• Close all curtains and blinds.

• Turn off major appliances ifadvised to do so, or if power fails.

• Make sure that all household petsare inside and keep them in petcarriers with adequate water.

• Go to your chosen safe place andstay under a table, if there is one.

• If you feel that the house is startingto collapse around you, try to movequickly under a sturdy bed or apile of mattresses; if there is notime to move, stay under the table.

3Stay safe• Be aware that when the eye of

the storm passes overhead, it mayappear that a hurricane is over.However, winds will start blowingagain from the opposite directionwithin the hour; this can often bethe worst part of the storm.

• Listen for warnings of tornadoes(p.236) or severe flooding (p.228),both of which often occur in thewake of a hurricane.

• Stay where you are until you aresure that the hurricane has passed.

1 Stay informed• Keep your radio on and listen

for updated local information andofficial instructions. You may beasked to turn off utilities or toevacuate at any point.

• If you are advised to evacuate,follow all the instructions carefully.

235

DURING A HURRICANE

!If you are outside• Lie flat on the ground and crawl on your

stomach to shelter, such as an outcrop ofrock, a ditch, or a low wall.

• Cover your head with your hands or a coat.

• Do not take shelter close to trees becausebranches may break off or trees may evenbe uprooted, and fall on top of you.

• During the eye of the storm, move to theother side of your shelter, since the wind willnow come from the opposite direction.

• After the winds die down, wait for at least11/2 hours before leaving your shelter.

HURRICANE

HELPING CHILDREN COPE

Comforting childrenReassure young children and calmtheir fears by holding them andgiving them plenty of attention.

Children may find a hurricaneterrifying, especially if theirhome and belongings aredamaged or an evacuation isnecessary. To help them feelmore secure, try the following.

• Explain that a hurricane is avery bad storm and that thefamily might need to go toa safer building.

• Ask children to help youwith simple tasks.

• Take playthings, such as cards,into the safe room or hurricaneshelter to keep children busy.

• Write each child’s name,address, and contact numberon a piece of paper andplace it in the child’s pocket.

3Get to safety• If you are told to evacuate, follow

the instructions carefully.

• Act promptly, but calmly. You mayhave only a short time to get tothe nearest hurricane shelter.

236

PREPARING FOR A TORNADO

For SEVERE STORM see p.226 For HURRICANE see p.234Tornadoes, tall columns of spinning air moving at high speeds, can causeimmense damage. Tornadoes usually occur in warm, humid, unsettled weather,but they can develop anywhere at any time, particularly after a thunderstormor hurricane. If you live in a tornado area, make sure that you are familiar withthe early warning system: a “tornado watch” indicates that a tornado is possible;and a “tornado warning” that a tornado has been seen and could be heading inyour direction. Depending on the severity and path of the tornado, either stayunder shelter or evacuate your home.

TornadoNATURAL DISASTERS

SIGNS AND WARNINGS

• Certain changes in weather conditions, suchas blowing debris or a sudden wind drop andunusually still air, may herald a tornado.

• In some circumstances, a low rumblingnoise, the sound of an approaching tornado,may be audible.

• Tornadoes can be seen approaching, oftenfrom a great distance, moving at speeds ofup to 30–40 mph (50–60 km/h).

• A tall funnel shapeof whirling air anddust will descendfrom underneatha storm cloud.

1Take precautions• Keep alert for a “tornado watch”

and listen to local radio stationsfor updates.

• Close hurricane shutters or boardyour windows (p.234) to protectyourself from flying glass (but seepoint 2 below).

• Choose a safe part of your housewhere family members can gatherif a tornado is on the way (p.234,Take precautions).

• Fill clean baths, sinks, containers,and plastic bottles with water toensure an uncontaminated supply.

• Fill your vehicle’s tank with fuel.

Violent tornadoThe characteristictwisting funnel of airand dust indicates anapproaching tornado.

2Listen for warning• If a “tornado watch” turns into a

“tornado warning,” be preparedto evacuate your home. If you arein a car, van, or mobile home, getout (see Stay safe, p.237).

• If warnings predict that your homewill be in the tornado’s direct path,open doors, shutters, and windowson the side away from the storm toprevent a buildup of air pressure.

Choose a sturdy piece offurniture as your shelter

2Stay informed• Listen to your radio for updated

local information and officialinstructions. You may be askedto turn off utilities or evacuate if the tornado alters course.

• If you are advised to evacuate,follow all instructions carefully.

1 Stay safe• If a“tornado watch” turns into a

“tornado warning” but you areadvised not to evacuate, go to yourchosen safe place in your house.

• Protect yourself and your family bycrawling under a heavy piece offurniture, such as a table or desk.

• If you are unable to hide underfurniture, sit down in the centerof the room and protect your headwith your arms.

• If you are in a car, van, or mobilehome, get out at once and headfor open ground. Lie down flatand cover yourhead. Vehicles canbe picked up by aforceful tornado andthen dropped again,so they are not safeplaces for shelter.

237

DURING A TORNADO

TORNADO

3Return home• Once the tornado has passed, wait

at least 5 minutes before leavingyour place of shelter.

Take your radiowith you tostay informed

!• Find the nearest sturdy building and head for

the basement or lay down on the ground floor.

• If you are close to a bridge, get underneath it.

• If there is no obvious shelter, lie flat on theground, away from trees or structures thatcould collapse, and ideally in a ditch. Coveryour head with your hands.

• Be aware of the dangers of flying objects,falling trees, buildings that may collapse,and damaged power lines.

• If you are in a car, do not try to outdrive atornado: if it changes course you will be indanger of being picked up in your vehicle.

• Get out of the car immediately and eitherfind shelter or lie in a ditch or other low-lying land with your hands over your head.

Protecting yourselfIf you are unable to locate a shelter, finda low-lying area and lie down, takingcare to protect your head.

Protect yourhead fromflying debris

If you are outside

3Be ready • Be alert for small tremors, known

as foreshocks. These indicate thata larger earthquake is on its way.If you do feel a foreshock, warnfamily members and head for asafe location at once.

• Be prepared to experience a rippleof aftershocks following the mainearthquake. These aftershockscan also be severe and may causeadditional damage.

2 Identify safeplaces• In every room, identify safe spots

where you could take shelter. Idealplaces are under sturdy desks,tables or strong internal doorwaywells away from windows, orplaces where glass could shatter.

• Identify at least one safe outdoorlocation that you could escape toif necessary. Try to find a spot thatis out in the open, well away frombuildings, trees, power lines, andelevated roads and bridges, all ofwhich are dangerous because theycould fall or collapse.

• Make sure that every member ofyour family knows what to do inthe event of an earthquake (p.239).

238

PREPARING FOR AN EARTHQUAKE

For WILDFIRE see p.232 For TSUNAMI see p.242 Earthquakes may strike along fault lines without warning, causing deaths andmajor damage. Often quakes last for only seconds, but in that time, they candestroy buildings and roads, and crush people. Fires resulting from brokengas pipes can rage for days afterward, and aftershocks are a further danger.If you live in an earthquake area, prepare your home as best you can.

Earthquake

SECURING FURNITURE

Attach steel strapsat top and bottom of

the boiler to secureit to the wall

Secure boilerUse galvanized steel straps,with holes punchedthrough them, to attacha boiler to the wall

Attach furnitureAttach exterior anglebrackets at the top orsides of tall furniturelike bookcases andwardrobes

Screw the bracketinto the wall andthe bookcase

1 Identify potentialhazards• Check structural elements in your

home (see p.222) to ensure thatthey are sound and see that heavyfurniture is secure (see box below).

• Place large, heavy objects on lowershelves and rehang heavy mirrorsor pictures that are currentlypositioned over seating or beds.

• Store fragile items in low cabinetsthat are fitted with latches or locks.

NATURAL DISASTERS

3Stay safe• If you are outside, do not go back

into your home until it has beenchecked for structural safety.

• If you are inside and your homeseems to be structurally sound, waitthere until you are given the officialall-clear. Then, prepare to leave.Stay elsewhere until your home hasbeen checked by a professional.

• Check everyone for injuries andgive first-aid treatment as necessary.

• If water pipes are damaged, turn offyour supply at the main.

• If you can smell gas or suspect thatelectrical wiring is damaged, turnoff supplies at the main.

• Keep listening to your radio forofficial instructions.2

1Take cover• If you feel the ground shake, drop

under a heavy desk or table, pressyour face against your arm toprotect your eyes, and hold on.

• If you cannot reach a table, takeshelter in an internal doorway.

• If you cannot move quickly to asafe place, stay where you are butkeep well away from windows.

• If you are in bed, stay there andprotect your head with a pillow.

• Stay exactly where you are untilthe shaking stops.

239

DURING AN EARTHQUAKE

EARTHQUAKE

DO’S AND DON’TS

DO

• Keep away fromwindows: they couldbe shattered.

• Take cover whereveryou are.

• Stay away from itemsthat might fall on you,such as tall furniture.

• Put out cigarettes incase of gas leaks.

DON’T

• Use stairs or elevators.

• Run into the street:falling bricks or glasscould injure you.

• Think that you aresafe once the groundstops shaking: alwaysexpect aftershocks.

• Use telephones unlessthe call is essential.

Expect aftershocks• Put out candles or naked flames in

case of gas leaks. If you smell gas,turn off the supply at the main.

• Each time you feel an aftershock,take cover and hold on, as before.

• Be aware that aftershocks cantopple structures already weakenedby earthquakes. Inspect your homefor damage after each aftershock,and move everyone out of thebuilding quickly if you suspectthat it is unsafe.

Cover your eyeswith your arm

Brace yourselfagainst a support

!If you are outside• Lie down as far away as possible from

buildings, trees, and power lines, or seekshelter in a doorway. Stay where you areuntil the shaking stops.

• Do not go into any form of undergroundshelter, such as a cellar or tunnel, becauseit could collapse.

• If you are driving, stop your car carefully andstay in your car until the shaking stops.

2Evacuate• If a volcano erupts without advance

warning, you may be advised toevacuate the area, in which caseyou should leave immediately.Make sure that you follow allevacuation instructions carefully.

• Put on goggles and a disposabledust mask. If you do not have amask, then improvise by wrappingeither a wet scarf or handkerchiefaround your face.

• To avoid skin irritation caused by ashfall, put on clothing thatcovers your entire body.

• Avoid areas that are downwind ofthe volcano because burning hotash and clouds of gases may beblown in your direction.

• Avoid river valleys and low-lyingareas, where mudflows may occur.

240

ESCAPING A VOLCANIC ERUPTION

For EARTHQUAKE see p.238 For TSUNAMI see p.242Often with little or no warning, volcanoes erupt, sending molten lava and mudflowing down the sides, clouds of ash billowing into the sky, and rock fragmentshurtling down to earth. You increase your chances of escaping unharmed if youleave the area as soon as you are advised to do so.

Volcanic eruption

1Be prepared• If you live anywhere near a

volcano, whether it is dormant oractive, keep a pair of goggles and

a disposable dust mask for eachfamily member.

• Make sure thatyou have plannedat least two routesout of the area,and arranged aplace to meetfamily members.

NATURAL DISASTERS

!Warning signsProfessional vulcanologists studygrumbling volcanos for indications ofactivity. The following are all warningsigns that a volcano is active and aboutto erupt:

• An increase in seismic activity, rangingfrom minor tremors to earthquakes.

• Rumbling noises coming fromthe volcano.

• A cloud of steam hanging over thetop of the volcano.

• A smell of sulfur from local rivers.

• Falls of acidic rain.

• Fine dust suspended in the sky.

• Occasional bursts of hot gases orash from the volcano top.

Goggles protect theeyes; make sure theyfit snugly

Wear a mask toprotect againstpoisonous gasesand dust

VOLCANO

241

DURING A VOLCANIC ERUPTION

VOLCANIC ERUPTION

1Follow instructions• If a volcano erupts while you are

at home, make sure that all familymembers and household pets areaccounted for, and close all yourdoors, windows, and vents.

• If you are not advised to evacuate,stay inside.

• Listen to your radio for officialinstructions. A period of calm mayfollow an eruption. Be preparedbecause you may be told to leavethen to escape further eruptions.

2Beware of ashfall• If you have breathing problems,

such as asthma, stay inside.

• Press damp towels firmly arounddoors and windows, and any otherdraft sources.

• Avoid driving: heavy ashfall clogsengines, often causing cars to stall.

• Clear volcanic ash from the roofof your house: its weight can causebuildings to collapse. Be carefulwhen working on the roof, andput on protective clothing, goggles,and a dust mask before going out.

3Stay safe• If you were evacuated, stay out of

any restricted areas until you aregiven the official all-clear.

• Be aware that mudflows, ashfall,flash floods, and wildfires can reachyou even if you are far from thevolcano and are unable to see it.

• When you return home, or if younever left, dampen and clean upash that has settled around thehouse, being careful not to wash itinto drains. Put on your protectiveclothing, goggles, and a dust mask.

!If you are outside• Try to get inside a building.

• If you are caught in a rock fall, roll into a ballto protect your head.

• If you suspect that you are in the path of anuée ardente (see box below), you cansurvive only by finding shelter undergroundor submerging yourself in water. The dangerusually passes in just 30 seconds.

• If you are caught near a stream, beware ofmudflows (see box below). Do not cross abridge if a mudflow is moving beneath itbecause the bridge could be swept away.

UNDERSTANDING THE DANGERS

• Ash and other debris raindown from the sky, coveringbuildings, land, and people.

• Debris flows are a mixture ofwater and volcanic debris thatflows down the volcano sides.They can travel long distancesand destroy whole villages.

• Mudflows are fast-movingrivers of mud that flow fromvolcanoes down river valleysand over low-lying areas.

• Lava flows are fairly unlikely tokill you because they moveslowly, but anything thatstands in their path will beburned, crushed, or buried.

• Pyroclastic surges are mixturesof rock fragments and hotgases that move rapidly acrossland like hurricanes. Anyonecaught in their paths is likelyto be burned, asphyxiated,or crushed.

• Nuées ardentes are rapidlymoving, red-hot clouds of ash,gas, and rock fragments thatflow down the side of avolcano at speeds of over100 mph (160 km/h).

RED-HOT LAVA FLOW

242

PREPARING FOR A TSUNAMI

For FLOOD see p.228 For EARTHQUAKE see p.238An earthquake, volcanic eruption, or underwater landslide can cause a tsunami: aseries of underwater waves that sweep towards shore, sometimes rising to heightsof over 100 ft (30 m), and causing immense damage. A “tsunami advisory”indicates that a tsunami is possible; a “tsunami watch” that a tsunami maybe 2 hours away; and a “tsunami warning” that giant waves may be imminent.If you live within 2 miles (3.2 km) of the shore and your house stands less than100 ft (30 m) above sea level, evacuate as soon as you receive a “tsunamiwarning” and move to high ground as far inland as you can go.

TsunamiNATURAL DISASTERS

UNDERSTANDING TSUNAMIS

Sea-borne disasterVast sea waves crash onto the shore,causing damage and claiming lives.

• Earthquakes, underwaterlandslides, or volcaniceruptions can cause tsunamis.

• Each tsunami consists of aseries of waves travelling atspeeds of up to 600 mph(970 km/h).

• These waves are hundreds ofmiles (kilometers) long butonly a few feet (about ameter) “tall” as they travelthe ocean floor. Hence, theycannot be detected from theair or at sea until they nearthe shore.

• Seismic activity may be the only advance warning of anapproaching tsunami.

• As the tsunami nears thecoast, the waves slow downand increase in height.

• Before the first wave reachesthe shore, the sea may bedramatically “sucked” awayfrom the shoreline.

• Successive waves appear atintervals of 5 to 90 minutes.

• The first wave is usually notthe largest; the following onescause the most damage.

2Take precautions• Keep your car filled with fuel so

that you can drive to safety at amoment’s notice.

• If a “tsunami watch” turns into a “tsunami warning,” prepare toevacuate your home.

• Coastal areas within 1 mile (1.6 km)of the sea and less than 25 ft(7.5 m) above sea level are most atrisk; make an early assessment ofthe best route to higher ground.

1Be aware• Keep alert for a “tsunami advisory”

or “tsunami watch,” and listen tolocal radio stations for updates.

• Check that your planned escaperoute is clear.

• Familiarize yourself with warningsigns, such as a sudden change inthe level of coastal waters.

• Tsunamis often cause severe floods;make sure that you are preparedto cope (p.228).

2Stay informed• Keep listening to your radio for

updated local information andofficial instructions.

• Stay inland and on high grounduntil the official all-clear is given.

• Be aware that atsunami is not justone wave, but aseries of waves, sothe risk of dangermay continue forhours. People whoreturn to their

homes afterthe first wave(often notthe biggest)risk drowning.

243

DURING A TSUNAMI

TSUNAMI

1Get to safety• If you are advised to evacuate,

follow all instructions carefullyand leave as quickly as possible.

• Go to your planned evacuationplace or follow instructions for arecommended evacuation route, ifissued. Your place of safety shouldbe at least 100 ft (30 m) above sealevel or 2 miles (3.2 km) inland.

3Check damage• When you are allowed to return to

your home, inspect the structure ofthe building carefully for cracks orweaknesses. Tsunami waters oftendamage foundations and walls.

• Enter cautiously because there maybe hazards hidden under the water.

• Check for potential fire hazards,such as broken gas pipes or floodedelectrical circuits.

4 Stay safe• Do not use tap water unless you

have been officially advised that it is safe to do so.

• Open doors and windows to helpthe building dry out.

• Inspect all your food and drinksupplies and throw away wet items.

• If you smell gas, turn off the supplyat the main, open your doors andwindows, and leave at once.

• If electrical wiring has become wetor damaged, turn off the electricitysupply at the main.

If you feel anearthquake on the coast• Drop to the ground, crawl to a sturdy shelter,

if possible, and put your hands over yourhead to protect it.

• When the shaking stops, gather your familyand evacuate. Move inland and to higherground as quickly as possible: a tsunami maybe only minutes away.

• Stay away from any structures that may havebeen weakened by the earthquake.

• Do not leave your place of safety until anofficial all-clear has been issued.

!

DO’S AND DON’TS

DO

• Go as far inland andas high as you can toescape the water.

• Be careful returninghome: the tsunamimay have causedstructural damage.

• Use bottled wateruntil you are told thattap water is safe.

DON’T

• Try to watch the giantwaves come ashore.

• Leave your place ofsafety after the firstwave: wait for theofficial all-clear beforereturning home.

• Enter your home witha naked flame: theremay be a gas leak.

244

Once a severe natural disaster is over, life may not return to normal for sometime; in the case of an earthquake or volcanic eruption, it may be weeks beforenormal life resumes. In the meantime, keep out of danger, find temporary shelter,if necessary, and conserve food and water supplies. Check your home for damage,and find temporary accommodation if you suspect that it may be unsound.

Post-disaster survivalNATURAL DISASTERS

ACTION PLAN

ACTION

TURN ON WATER ANDELECTRICITY AND GETYOUR GAS PROVIDERTO TURN ON THE GAS.

ACTION

GIVE APPROPRIATEFIRST AID (pp.8–63)AND SEEK MEDICALHELP IF NEEDED.

ACTION

IF YOU EVACUATED,WAIT UNTIL THE ALL-CLEAR BEFORERETURNING HOME.

Yes

No

Are you inyour home?

No

Yes

Might yourhome have

been damaged?

START

ACTION

TRY TO CONTACTMISSING MEMBERSOF THE FAMILY. MAKEARRANGEMENTS FORFAMILY MEMBERSUNABLE TO RETURNHOME (p.245).

Yes

No

Is it safe toturn on main

supplies(p.248)?

Yes

No

Are any familymembersinjured?

Yes

No

Is the familytogether?

ACTION

CHECK FOR DAMAGE(p.248).

ACTION

WAIT UNTIL THESITUATION HASIMPROVED OR SEEKADVICE FROM YOURSERVICE PROVIDERS.

3Make contact• If you have been separated from

family members who were unableto find shelter in the house withyou, you will want to makecontact as soon as possible.

• Try to get in touch by cellularphone or call the friend or relativeat the second emergency meetingplace in your disaster plan (p.223).

• Keep calls to a minimum to avoidblocking lines badly needed by theemergency services.

• If you can move around safely inthe local area, visit neighbors,especially the elderly or disabled,to see if they need help or supplies.

• If you were not at home whenthe disaster struck, contact familymembers as soon as possible toreassure them that you are safe.

4 Try to reach help• If you or your family were not at

home and now cannot get home,to your second meeting place,or to an evacuation shelter, youmay have to survive outside untilhelp arrives. (See pp.246–7 foradvice on surviving outside.)

245POST-DISASTER SURVIVAL

1Assess situation• If the disaster was severe but you

remained in your home, you willusually be advised to stay thereunless you think that the buildingis structurally unsound.

• You are generally safer in yourhome, away from external dangers.By staying inside, you will notobstruct the emergency services.

• Check your home for minordamage, some of which you maybe able to repair, and for the safetyof main supplies (p.248).

• Listen to your radio or watchtelevision (if you have electricity)to assess the scale of the disasterand its aftermath.

• If the incident had minor or noeffects on your home and family,resume your normal daily activities,but be aware that nearby areasmay have been more seriouslyaffected and could be dangerous.

2Treat injuries• If any members of the family have

been injured during the disaster,give them appropriate first-aidtreatment (pp.8–63). Always seekmedical help if injuries are severe.

IMMEDIATE AFTERMATH

DEALING WITH STRANDED FAMILY MEMBERS

• If the disaster has caused local damage, such asroads blocked by fallen trees or flooding, schoolchildren may not be able to return home thatevening. Ask a friend to collect them and keepthem for the night.

• If the situation is severe, you may need to makearrangements for your children for a few daysuntil travel is possible.

• If you cannot make contact with your strandedchildren for any reason, ask the emergencyservices for help.

• Family members working outside the immediatearea may also be stranded and unable to returnhome. They will need to make alternativeaccommodation arrangements until thesituation improves.

246

2Find shelter• If you had to evacuate your home

but did not manage to reach eitheryour chosen place of evacuation ora local emergency shelter, you willneed to find some form of shelterfor your family.

• If you are in a town, try to findan empty building to take shelterin. Avoid buildings that look asthough they may be structurallyunsound, especially followingan earthquake.

• If you are in the countryside, lookfor a manmade structure, such asa bridge, barn or shed. As a lastresort, trees will at least protectyou from extremes of temperature,wind, rain, or snow.

• Use the bedding supplies in yourdisaster emergency kit (p.225) tokeep warm at night.

SURVIVING OUTSIDE

!

1Avoid danger• Any post-disaster area will be full

of potential hazards, so stay alertand move around carefully.

• Keep well away from damagedpower lines: high-voltage electricityis very dangerous and can causeelectrocution and fire.

• Leaking gas pipes are also a danger.If you smell gas, you should leavethe area immediately.

• If sewage pipes are damaged, thereis the risk that raw sewage couldspill out in the open, leading to therapid spread of disease.

• Buildings that are unstable due toa natural disaster could topple atany time. Keep away from tallbuildings and structures.

Cold exposure• If the weather is very cold and you cannot

find shelter, you are at risk of developingfrostbite (p.55) and/or hypothermia (p.54).

• Symptoms of frostbite include “pins-and-needles,” followed by numbness. Skin maybe white, mottled and blue, or black.

• Symptoms of hypothermia include verycold skin, shivering, apathy, poor vision,and irritable behavior.

• For either condition, put the victim in asleeping bag or wrap her in a survivalblanket (covering the head too).Frostbitten fingers may be tuckedunder the armpits for extra warmth.Give warm, sweet drinks.

!Heat exposure• Prolonged exposure to strong sunlight

can lead to sunburn (p.50), heatexhaustion (p.51), heatstroke (p.52), and resulting illness.

• Move the victim of any of theseconditions to a cool place.

• Cool sunburned skin with cold waterand give the person cold drinks to sip.

• Symptoms of heat exhaustion areheadache, dizziness, nausea, and rapidpulse. Give the person an isotonic drinkor a weak salt and sugar solution (p.51).

• Symptoms of heatstroke are headache,dizziness, flushed skin, and, in seriouscases, unconsciousness. Remove thevictim’s outer clothing, lay him or herdown, then cool the skin by repeatedlysponging cold water over it.

NATURAL DISASTERS

Keeping warmWrap the victim in asurvival blanket, andcover her head if she isnot wearing a hat.

247

3Create shelter• If you cannot find shelter, try to

build something with materialsyou have or find.

• You need to build a structure thatwill provide adequate protectionfrom the wind, rain, and sun.

• If you are in the countryside, youcould use vegetation and branchesto construct a lean-to shelter.

• If you are in a town, huntaround for sheets of metal,plastic sheeting, pieces of wood,or anything else that could beused to create a shelter.

• Involve all family members inconstructing the shelter. Not onlywill the work be done more quickly,but it will keep you all occupied.

5Build fire• If it is cold, build a fire. If you are

in the countryside, use twigs andsmall branches, but be aware ofthe dangers of starting a wildfire.If you are in a town, use whatevermaterials are available.

• If you have suitable containerswith you, you may be able to heat

up some of youremergency food.

4Keep positive• Unpack your disaster emergency

kit and find places for everyoneto spread out their sleeping bags.Make your shelter as comfortableas possible.

• Comfort young children by tellingthem how exciting your “camping”experience will be.

• Try to keep up morale with thethought that you are all safe andthat this is only a temporarysituation until help arrives.

POST-DISASTER SURVIVAL

Find somethingwater-resistant touse as a floor

Make a roof out ofvegetation strappedto a wooden frame

6Conserve foodand water• If you are unable to reach safety

or help fails to arrive within 2days, think about conserving yoursupplies of food and water.

• Restrict adult rations but givechildren, the elderly, and pregnantwomen normal supplies, if possible.

• Be aware that water is more vitalthan food: a healthy adult cansurvive without food for a weekwith no serious health effects, butmore than 1–2 days without watercan be highly dangerous.

• If water supplies run low, collectrainfall to drink.

• Alternatively, find the cleanest-looking source you can and purifywater to make it drinkable (p.249).

• Do not drink water from streamsor damaged pipes: it could becontaminated and could seriouslydamage your health.

248

4Contact yourinsurance company• Call your insurance company’s

emergency helpline as soon aspossible. You will be given adviceon what to do.

• If immediate repairs are necessary,arrange for them to be carried outstraight away. Keep the receiptsto give to your insurers later.

• Your insurance company will senda loss adjuster to assess extensivedamage and the cost of reparation.

• Take photographs or videos of thedamage to corroborate insuranceclaims. Keep copies of all yourcorrespondence with insurers.

1Check for damage• Do not enter your home if there is

water around it. Flood water canundermine foundations, causingbuildings to sink, floors to crack,or walls to collapse.

• Check the outside of your homefor signs of structural damage,such as cracks in walls, a leaningchimney, and walls at angles.

• If you are certain that it is safe toenter your home, go inside andinspect the walls, floors, windows,doors, and staircases for damage.

• Do not enter your home carryingany naked flame, such as a lightedcigarette, in case of gas leaks.

• If you are unsure, ask a structuralengineer to inspect your home.

2Check safety ofmain supplies• If you remained in your house and

did not turn off main supplies, beaware of the possible dangers.

• If wiring has been damaged, turnoff electricity at the main and askan electrician to inspect it.

• If you can smell gas, turn off thesupply at the main, open doorsand windows, and leave at once.

• If sewage pipes are damaged, turnoff your water supply at the mainshutoff valve (outside your house)to prevent contaminated waterfrom entering your water system.

• Do not drink tap water unless youhave been officially told it is safe.

• If you turned off main suppliesbefore the disaster, and are certainthat they are safe, turn on thewater and electricity, and ask yourgas supplier to turn on the gas.

3Make repairs• Check for minor damage, such as

cracked or missing roof tiles andleaks, in your home. Remedy anyproblems as quickly as possible.If necessary, use short-termsolutions until proper repairwork can be undertaken.

• If your home has been shaken bythe disaster, causing breaks andspills, clean up dangerous debris asquickly as possible. Shattered glassand spilled flammable liquids andbleaches are potentially dangerous.

CHECKING YOUR HOME

NATURAL DISASTERS

Clear up anybreaks and spills

249POST-DISASTER SURVIVAL

LOOKING AFTER YOUR FAMILY

1Cope withpower loss• You may have to cope without

supplies of gas and electricity fora period of time, particularly if thedisaster has been serious enoughto affect the local infrastructure.

• Use flashlights or candles at night,but conserve supplies by usingthem only if absolutely necessary.

• If you have a working hearth andchimney, forage for wood to burn,but be aware of the danger ofchimney fires in a dirty chimney.

3Keep up morale• The aftermath of a major natural

disaster will be a difficult period.Family members or friends may beunaccounted for, you may have tocope with injuries, and there willalmost certainly be damage andsuffering all around.

• Help your family remain positiveand keep them focused on the issueof survival. Keep busy and try towork together as a team, makingsure that you discuss all plans.

• Reassure young children that youhave survived and that the worstis over. Keep them entertained todistract them.

• Bear in mind the comfort factor offood. In a time of great stress andupheaval, a familiar food or drinkcan be very reassuring.

2Use food sensibly• Without electricity to power

refrigerators and freezers, chilled orfrozen foods will become inedible.

• In order to conserve the cold airinside, avoid opening fridge andfreezer doors.

• A fully stocked, well-insulatedfreezer should keep foods frozenfor at least 3 days, so use suppliesfrom the fridge first. Only foodsthat do not require cooking willbe usable, unless you have acamping stove.

• Once you have finishedthese supplies, eat cannedand dried foods.

PURIFYING WATER

If water supplies run low and main water iscontaminated, you will have to purify water.

• If you can see particles floating in water, strain it through some paper towels then boil it, addpurifying tablets, or disinfect it.

• Boil some water for 10 minutes to purify it, thenallow it to cool before drinking.

• Use chlorine-based tablets to purify water.

• To disinfect water, use regular household bleachcontaining 5.25 percent sodium hypochloriteonly. A stronger percentage is dangerous.

• Add two drops of bleach to 1 pt (500 ml) ofwater, stir and leave it to stand for 30 minutes.The water should smell slightly of bleach. If itdoes not, repeat the process and leave thewater to stand for 15 minutes more.

250

FIRST-AID ORGANIZATIONS

American First Aid4306 State Route 51 SouthBelle Vernon, PA 15012Tel: (800) 831-9623Online: www.amfirstaid.com

American Red CrossP.O. Box 37243Washington, DC 20013. Tel: (800) 435-7669Online: www.redcross.org

National Safety Organization1121 Spring Lake DriveItasca, IL 60143-3201Tel: (630) 285-1121Online: www.nsc.org

DIY HELP

AmeriSpec: Home Inspection ServiceThe ServiceMaster CompanyOne ServiceMaster Way Downers Grove, IL 60515Tel: (800) WE-SERVEOnline: www.amerispec.com

Arctic Council - EmergencyPrevention, Preparedness, and ResponseSuite 301, 5204-50 Avenue Yellowknife, NT XIA IE2Canada Tel: (867) 669 4725Online: http://eppr.arctic-council.org

Emergency Services WWW Site ListOnline: www.district.north-van.bc.ca/eswsl/www-911.htm

Southern Union Gas CompanyEmergency Tel:(800) 959-LEAK/959-5325

GENERAL HEALTHCARE

Agency for HealthcareResearch and Quality2101 E. Jefferson St., Suite 501Rockville, MD 20852Tel: (301) 594-1364Online: www.ahcpr.gov

American Alliance for Health, PhysicalEducation, Recreation, and Dance1900 Association Dr.Reston, VA 20191-1598Tel: 1-800-213-7193Online: www.aahperd.org

American Health Care Association1201 L St., N.W.Washington, DC 20005Tel: (202) 842-4444Online: www.ahca.org

American Institute of Homeopathy801 N. Fairfax Street, Suite 306 Alexandria, VA 22314 Tel: (888) 445-9988Online: http://www.homeopathyusa.org

American Medical Association515 N. State StreetChicago, IL 60610 Tel: (312) 464-5000 Online: www.ama-assn.org

American Medical Women’s Association801 N. Fairfax Street, Suite 400Alexandria, VA 22314Tel: (703) 838-0500Online: www.amwa-doc.org

Canadian Health NetworkOnline: www.canadian-health-network.ca

Family Health InternationalP.O. Box 13950Research Triangle ParkNC 27709Tel: (919) 544-7040Online: www.fhi.org

HealthNet Canada4271 - 99 Fourth AvenueOttawa, Ontario K1S 5B3CanadaTel: (613) 220-0623Online: www.healthnet.ca

National Institute on AgingBuilding 31, Room 5C2731 Center Drive, MSC 2292Bethesda, MD 20892Tel: (301) 496-1752Online: www.nia.nih.gov

The Emergency Medicine andPrimary Care Home PageOnline: www.embbs.com

MASTER TRADESMEN

Lockmasters, Inc.5085 Danville Rd.Nicholasville, KY 40356-9531Tel: (800) 654-0637Online: www.lockmasters.com

Master Builders Association2155 112th Ave NEBellevue, WA 98004Tel: (800) 522-2209Online:http://www.mbaks.com

NATURAL DISASTERS

Alzheimer’s Association919 North Michigan Avenue,Suite 1100Chicago, Illinois 60611-1676Tel: (800) 272-3900Online: www.alz.org

American Red CrossP.O. Box 37243Washington, DC 20013. Tel: (800) 435-7669Online: www.redcross.org

Useful online sites and addresses

USEFUL ONLINE SITES AND ADDRESSES

251

Disaster Survival Planning Network669 Pacific Cove DrivePort Huenene, CA 93041Tel: (800) 601- 4899Online:www.disaster-survival.com

Environmental ProtectionAgencyAriel Rios Building1200 Pennsylvania Avenue,N.W. Washington, DC 20460Tel: (202) 260-2090 Online: www.epa.gov/

Federal EmergencyManagement AgencyTel: (800) 480-2520Online: www.fema.gov

Geological Association of CanadaDepartment of Earth Sciences Room ER4063, AlexanderMurray Building Memorial University ofNewfoundland St. John’s, NF A1B 3X5CANADA Tel: (709) 737-7660 Online: www.gac.ca

Geological Society of AmericaP.O. Box 9140Boulder, CO 80301-9140Tel: (303) 447-2020Online: www.geosoceity.org

National Oceanic andAtmospheric AdministrationNational Weather Service1325 East West HighwaySilver Spring, MD 20910Online: www.nws.noaa.gov

National Severe Storms Laboratory1313 Halley CircleNorman, Oklahoma 73069Tel: (405) 360-3620Online: www.nssl.noaa.gov

The Global EarthquakeResponse CenterOnline: www.earthquake.com

The Weather Channel OnlineOnline: www.weather.com

The Weather Network (USA and Canada)Online:www.theweathernetwork.com

United States Geological SurveyNational EarthquakeInformation CenterBox 25046, DFC, MS 967Denver, Colorado 80225Tel: (303) 273-8500Online: http://neic.usgs.gov

Vortech Storm Research OrganizationP.O. Box 1233 Danbury, CT 06813-1233Online: http://vortechstorm.tripod.com

home SECURITYAmerican Society for Industrial Security1625 Prince StreetAlexandria, Virginia 22314-2818 Tel: (703) 519-6200Online: www.asisonline.org

Canadian Resource Centre for Victims of Crime100 - 141, rue Catherine Street Ottawa, OntarioK2P IC3Tel: (613) 233-7614Online: www.crcvc.ca

National Organization for Victim Assistance1730 Park Road NWWashington DC 20010Tel: (202) 232-6682Online: www.try-nova.org

The National Center for Victims of Crime2000 M Street NW, Suite 480Washington, DC 20036Tel: (202) 467-8700 Online: www.ncvc.org

SPECIFIC HEALTHPROBLEMS

American Academy of Allergy,Asthma, and Immunology611 East Wells StreetMilwaukee, WI 53202Tel: (414) 272-6071Online: www.aaaai.org

American Academy of DermatologyP.O. Box 4014Schaumburg, IL 60168-4014Tel: (847) 330-0230Online: www.aad.org

American Academy of OphthalmologyP.O. Box 7424San Francisco, CA 94120-7424Tel: (415) 561-8500Online: www.aao.org

American Academy ofOrthopaedic Surgeons6300 North River Road Rosemont, Illinois 60018-4262 Tel: (847) 823-7186Online:http://orthoinfo.aaos.org

American Diabetes Association1701 North Beauregard StreetAlexandria, VA 22311Tel: (800) DIABETESOnline: www.diabetes.org

American Epilepsy Society342 North Main StreetWest Hartford, CT 06117-2507Tel: (860) 586-7505Online: www.aesnet.org

American GastroenterologicalAssociation7910 Woodmont Ave., Seventh Floor, Bethesda, MD 20814Tel: (301) 654-2055Online: www.gastro.org


252

American Heart AssociationNational Center7272 Greenville AvenueDallas, TX 75231Tel: (800) AHA-USA-1Online:www.americanheart.org

American Lung Association61 Broadway, 6th FloorNY, NY 10006Tel: (212) 315-8700Online: www.lungusa.org

American Stroke AssociationNational Center7272 Greenville AvenueDallas TX 75231Tel: (888) 4-STROKEOnline:www.strokeassociation.org

Crohns and Colitis Foundationof America386 Park Avenue South, 17th FloorNew York, NY 10016Tel: (800) 932-2423Online: www.ccfa.org

Head Injury Resource Center212 Pioneer Bldg Seattle, WA 98104-2221 Tel: (206) 621-8558Online: www.headinjury.com

Incontinence.orgOnline: www.incontinence.org

International Society forSexual and ImpotenceResearchOnline: www.issir.org

P.O. Box 94074Toronto, Ontario M4N 3R1CanadaOnline: www.ibsgroup.org

MAGNUM, Inc.The National Migraine Association113 South Saint Asaph, Suite 300Alexandria, VA 22314Tel: (703) 739-9384Online: www.migraines.org

Meningitis Foundation of America Inc.6610 North ShadelandAvenue, Suite 200Indianapolis, Indiana 46220-4393Tel: (800) 668-1129Online: www.musa.org

National Alliance of BreastCancer Organizations9 East 37th Street, 10th FloorNew York, NY 10016Tel: (888) 80-NABCOOnline: www.nabco.org

National Eczema Associationfor Science and Education6600 SW 92nd Ave., Ste. 230Portland, OR 97223-0704Tel: (800) 818-7546Online:www.nationaleczema.org

National Prostate Cancer Coalition1158 15th St., NWWashington, DC 20005Tel: 202-463-9455Online: www.4npcc.org

TRADE ASSOCIATIONS

American Society of Heating,Refrigerating, and Air-Conditioning Engineers, Inc.1791 Tullie Circle, N.E.Atlanta, GA 30329Tel: (800) 527-4723Online: www.ashrae.org

American Wood-Preservers’AssociationP.O. Box 5690 Granbury Texas 76049-0690 Tel: 817-326-6300Online: www.awpa.com

Canadian Security IndustryOnline: www.csio.net

National Electrical Contractors Association 3 Bethesda Metro Center, Suite 1100 Bethesda, MD 20814 Tel: (301) 657-3110Online: www.neca-neis.org

National Glass Association8200 Greensboro Drive, Suite 302McLean, VA 22102-3881Tel: (866) DIAL-NGAOnline: www.glass.org

National Pest Management Association8100 Oak StreetDunn Loring, VA 22027Tel: (703) 573-8330Online: www.pestworld.org

National Roofing Contractors Association10255 W. Higgins Road, Suite 600Rosemont, IL 60018Tel: (847) 299-9070Online: www.nrca.net

Plumbing-Heating-CoolingContractors – NationalAssociation180 S. Washington StreetP.O. Box 6808Falls Church, VA 22040Tel: (703) 237-8100Online: www.phccweb.org

Plumbing Related Associations& Organizations on the WebOnline: www.plumbingweb.com/assn.html

Security Industry Association635 Slaters Lane, Suite 110Alexandria, VA 22314-1177Tel: (703) 683-2075Online: www.siaonline.org

TRAVEL ADVICE

Travel Advice5545 South 1025 EastSouth Ogden, UT 84405 Tel: (800) 854-3391Online: www.traveladvice.com


253

Aabdomen, swollen 126abdominal pain 120–1

children 124–5women 122–3

abrasions 33accident prevention

home 172–7yard 178–9

air-conditioning problems194–5

airlock in water pipe 190alcohol, safe limits 72, 79ambulance, calling 11anaphylactic shock 28animal bites 58ankles, swollen 148–9ants 208anus, problems 127arm

broken 44painful 144sling 63

asthma attack 26giving medication to baby

or child 167attic safety 177

Bbabies

asthma medication, giving 167

choking 24resuscitation techniques

12–15, 17, 20back pain 140–1bandaging 61–3bathroom safety 176bedroom safety 176

child’s 177bees 209bites 57–8bladder, poor control 137bleeding

abnormal vaginal 158–9heavy periods 157hormonal contraceptives 159mouth 38nose 39pregnancy, vaginal 158purpura 97

severe 31tooth knocked-out 38

bloodcoughing up 106in feces 132in semen 152

boundaries of yardfencing, broken or unstable

205gate, broken or unstable 205security 179

break-ins 216–17breasts

problems 154–5self-examination 69

breathingchecking for 14checking rate 68, 71children’s problems 112–13rescue breaths, giving 16–17,

19shortness of breath 110–1

broken arm 44broken leg 45burns 48–9burst water pipe 188

Ccar stuck in snow 231carbon monoxide alarms 173,

185cardiopulmonary resuscitation

see CPRcaring for a sick person 164–9carpet stains 210–11ceiling, leaking 187central-heating problems

192–3chemicals in eye 37chest

pain 134–5penetrating wounds 32

childbirth, emergency 40–1children

abdominal pain 124–5asthma medication, giving

167bedroom safety 177breathing problems 112–13choking 22–23coughing 108–9diarrhea 130–1

ear drops, administering 167eye drops, administering 166eye ointment, administering

166febrile seizures 43fever 76–7liquid medicines, giving 168nose drops, administering

166resuscitation techniques

12–16, 18–19symptoms of illness, assessing

70–1temperature, measuring 70vomiting 118–19

chimney fire, putting out 183choking 22–3

babies 24clothes on fire, putting out 182cockroaches 208cold weather, extreme 230–1,

246complementary remedies 163confusion 92–3consciousness, checking for 12constipation 132–3contraceptives, hormonal 159contact lens, pain or irritation

98convulsions 42

febrile 43coughing 106–7

children 108–9CPR (cardiopulmonary

resuscitation) 12, 18–20cuts 33

Ddehydration 128

preventing 165diarrhea 128–9

children 130–1difficulty speaking 91difficulty swallowing 115disasters, natural

emergency kit 224–5planning for 220–5post-disaster survival

244–9discharge, vaginal 160doors

chain 213

Index

INDEX

254

doors (continued)hinge bolts 214hinges badly fitting 203locks 212, 213,

jammed 215deadbolt 214mortise lock, damaged 215peephole 213security devices 212

sticking 202wood rot 204

Eear

drops, administering 167earache 102

early warnings 223earthquake 238–9, 243electrical fire, putting out 183electrical problems 196–9electrical wire, worn 199electricity and water, dangers

of 187emergency, action in 10–1erection failure 150evacuation from home

domestic emergencies 173family disaster plan 223natural disasters 224

exercises, relaxation 169eye

chemicals in 37contact lens 98drops, administering 166foreign object in 36ointment, administering 166painful or irritated 98–9vision, disturbed or impaired

100–1wound 35

Ffacial pain 90fainting 53family members, dealing with

stranded 245faucet, leaking 190

silencing drips 190faulty appliance, fuse and plug

checks 197febrile seizures 43feeling faint 82–3feeling unwell 72–3fencing, broken or unstable

205

fever 74–5bringing down 164children 76–7with rash 96–7

fires in the homeescaping from 181precautions 172, 173, 180putting out 182–3

first-aid equipment 60fleas 208floods 228–9foot, applying a bandage 62foreign object in eye 36forgetfulness 92–3frostbite 55frozen water pipes 188fuse problems 197–8

Ggarage safety 179

protection from naturaldisaster 222

gas leaks 184–5gate, broken or unstable 205genital irritation, women 161glands, swollen 80–1glass

replacing 200–1securing broken pane 200

grease stains 210–11gutters, leaking 207

Hhall safety 175hand

applying a bandage 62painful 144

head injury 29headache 84–5heart

attack 25palpitations 136

heatexhaustion 51exposure 246

heatstroke 52height, assessing children’s 71hoarseness 104–5home first-aid kit 60home medicine chest

162–3home safety 172–7hornets 209hurricane 234–5hypothermia 54

Iimpotence 150injuries

head 29spinal 46sprains and strains 47

insectscontrol 208–9stings 59

intruders, dealing with 216

itchiness, relieving 165

Jjoints

painful 146–7sprains 47

Kkitchen safety 174

Lleg

broken 45painful 145

ligamentssprains 47torn leg 145

lightning 227locks

door 212, 213jammed 215mortise damaged 215windows 212, 213

loss of voice 104–5lumps 80–1

breasts, self-examination 69scrotum 151testes 151, self-examination

69

Mmajor seizures 42medicines

complementary remedies 163conventional 162–3home medicine chest 162–3liquid, giving to children 168vomiting, effect on 117

mice 209mortise lock, damaged 215mouth

bleeding 38

INDEX

255

mouth (continued)stings 59tooth knocked-out 38

musclespulled leg 145strains 47

Nneck, pain or stiffness 142–3nose

bleed 39blocked, relieving 165drops, administering 166

numbness 88–9

Ooverflow pipe, dripping

191

Ppain

abdominal 120–1arm 144back 140–1chest 134–5eye 98–9facial 90hand 144joints 146–7leg 145neck 142–3periods 156urination 138–9

palpitations 136panic attack 168passing out 82–3path safety 179patio safety 179

door locks 212peephole in door 213penis problems 152–3periods

heavy 157painful 156

pest control 208–9pet stains on carpets and

upholstery 211pipes, water

airlock in 190burst 188dripping overflow 191frozen, thawing 188leaking 207

plug, electrical 197

plumbing problems 186–91poisons, swallowed 56pregnancy

abdominal pain 122vaginal bleeding 158

pulled leg muscle 145pulse, taking 68

children 70purpura 97

Rradiator problems 193rash 94–5

purpura 97with fever 96–7

rats 209rectum, problems 127red wine on carpets 211relaxation exercises 169resuscitation techniques 12–20rewiring a plug 197roof, leaking 206

Ssafety

home 172–7yard 178–9

sandbags 228scalds 49scorpion stings 59scrotum, problems 151security in the home 212–14seizures

febrile 43major 42

semen, blood-streaked 152shed safety 179shock 27

anaphylactic 28shortness of breath 110–11sink, blocked 189sitting room safety 175skillet fire, putting out 183skin

general problems 94–5rash with fever 96–7relieving itchiness 165stings 59sunburn 50

smoke alarms 173snake bites 57snow, car stuck in 231sore throat 103

difficulty swallowing 115soothing 164

speaking, difficulty 91spider bites 57spinal injuries 46splinters 34sprains 47stains on carpets and

upholstery 211stairs safety 175stings 59storm, severe 226strains 47stroke 30structural problems 200–7sunburn 50survival, post-disaster

244–9swallowed poisons 56swallowing, difficulty 115sweating, excessive 78–9

heat exhaustion 51swellings 80–1

abdomen 126ankles 148–9scrotum 151testes 151

symptoms, assessing 68–69children 70–1

Ttaking a pulse 68

children and babies 70temperature of body

febrile seizures 43fever 74–5,

children 76–7hypothermia 54measuring with athermometer 68

children 70tendons, strains 47testes

problems 151self-examination 69

thermometer 68, 70throat, sore 103

difficulty swallowing115soothing 164

tick bites 58tingling 88–9toilet, blocked 191tooth, knocked-out 38torn leg ligament 145tornado 236–7tsunami 242–3tubular bandage 62

INDEX

256

Uunconsciousness 21, 82–3

fainting 53resuscitation techniques

12–20upholstery stains 210, 211urine

appearance of 138bladder, poor control 137inability to pass 137painful urination 138–9pet stains on carpets andupholstery 211

Vvagina

abnormal bleeding 158–9discharge 160

vertigo 86–7vision, disturbed or impaired

100–1voice, loss of 104–5volcanic eruption 240–1vomiting 116–17

children 118–19

Wwall socket, faulty 199wallpaper, grease on 211wasps 209water

conservation during a disaster 247

electricity and, dangers of 187

plumbing mishaps 186–91purifying 249tank, leaking 187yard safety 178

weightassessing adults 69assessing children 71

wheezing 114wildfire 232–3windows

boarding 234frames with wood rot 204hinges badly fitting 203insulating 230joints damaged 202locks 212, 213sash damaged 203security devices 212

sticking 202see also glass

wine on carpets 211women

abdominal pain 122–3breast problems 154–5genital irritation 161periods, heavy 157, painful 156vagina, abnormal bleeding

158–9, discharge 160

wood rot 204woodworm 209wounds

applying a dressing 61cuts 33eye 35grazes 33penetrating chest 32

Cooling Brown would like to thank DerekCoombes, Elaine Hewson, and Elly Kingfor design assistance, Kate Sheppard foreditorial assistance, Dennis Fell for adviceon air conditioning, and G. R. Coleman.

Dorling Kindersley would like to thankAndrea Bagg and Martyn Page for theireditorial help, and Franziska Marking forpicture research.

MODELS

Philip Argent, Flora Bendall, ImogenBendall, Jennifer Bendall, Ross Bendall,Alison Bolus, Eleanor Bolus, Dale Buckton,Angela Cameron, Madeleine Cameron,Shenton Dickson, Olivia King, MichelLabat, Janey Madlani, Tish Mills

INDEX

Patricia Coward

ILLUSTRATORS

David Ashby, Kuo Kang Chen, PeterCooling, Chris King, Patrick Mulrey,John Woodcock

PHOTOGRAPHERS

Matthew Ward, Trish Grant

PICTURE CREDITS

Colin Walton 210b, Corbis 236, Photodisc240, 241, 242

JACKET PICTURE CREDITS

Pictor International front bl, front br;Popperfoto front bc; Science Photo LibraryBSIP, Laurent front tr; Stone/Getty Imagesback tc, back tl, front tc, front tl, spine.

All other images © Dorling Kindersley. For further information see:www.dkimages.com

Acknowledgments

INDEX • ACKNOWLEDGMENTS

School

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

School

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Burglar alarm company

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Place of work

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Taxi service

Name ..................................................................

Telephone ..........................................................

EMERGENCYCONTACTS

• In the event of an emergencygo to the nearest telephoneand dial 911

• Ask for the police, ambulanceor fire department

Local police station

Address...............................................................

............................................................................

Telephone ..........................................................

Landlord or superintendant

Name ..................................................................

Telephone ..........................................................

Relative

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Cell......................................................................

Neighbour

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Cell......................................................................

In case of an emergency please call

Name................................................................................

Telephone........................................................................

Cell ...................................................................................

Dentist

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Emergency telephone .......................................

Vet

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................


Town council or community board

Telephone ..........................................................

Flooding information

http://www.fema.gov

Water

Water supplier ...................................................

Telephone ..........................................................

Plumber..............................................................

Telephone ..........................................................

Cell......................................................................

Location of water main valve...........................

............................................................................

Gas

Gas supplier .......................................................

Telephone ..........................................................

Gas engineer......................................................

Telephone ..........................................................

Cell......................................................................

Location of gas main.........................................

............................................................................

Electricity

Electricity supplier .............................................

Telephone ..........................................................

Electrician...........................................................

Telephone ..........................................................

Cell......................................................................

Location of service box .....................................

............................................................................

Home insurance company

Name...............................................................

Address ...........................................................

.........................................................................

Telephone .......................................................

Policy number.................................................

Contents insurance company

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Policy number ....................................................

Physician

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................


Local hospital

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

Local pharmacist

Name ..................................................................

Address...............................................................

............................................................................

Telephone ..........................................................

HOME EMERGENCY GUIDE · YOU CAN DO SO WITHOUT PUTTING YOURSELF AT RISK. DIAL 911. ACTION PLACE VICTIM IN THE RECOVERY POSITION (pp.14–15). CHECK FOR SIGNS OF INJURY. DIAL 911 OR

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