Handling Minor Injuries, Illnesses During Pandemic
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During the coronavirus pandemic, whether to seek in-person medical care for minor to moderate illnesses or injuries has become a thorny issue. Should you ask for a same-day appointment with your primary care doctor if you have been vomiting and suspect food poisoning? Head for the nearest urgent care or emergency room if you slice your finger while chopping vegetables?
Barring a true potential emergency, such as significant difficulty breathing, an unconscious family member, coughing up or vomiting blood, signs of stroke, or chest or other severe pain (especially abdominal)—in which you should call 911 right away—the smartest first move right now may be a virtual visit.
“If you think you need to see someone, always call your doctor’s office first—sometimes they may be able to troubleshoot with a telemedicine visit,” says Baruch Fertel, M.D., an emergency medicine physician at the Cleveland Clinic.
In some cases, you may also be able to treat yourself (or a family member) at home, with or without your doctor’s input.
Here’s a guide to handling problems such as stomach bugs, cuts, sprains, respiratory conditions, and more without leaving home—plus when you should seek a physician’s assistance stat.
Respiratory Infections
At this moment, having a cough and other signs of a possible respiratory infection may be especially worrisome because it’s sometimes hard to tell whether you’re dealing with a cold or COVID-19.
Some symptoms overlap: Colds tend to bring coughs, congestion, runny nose, and sore throat, and, less often, fever and headaches. COVID-19’s common signs are cough, fever, and fatigue, but it may bring shortness of breath, body aches, chills, diarrhea, nausea, headaches, runny nose, sore throat, and loss of taste or smell.
But both, at least initially, are treated the same way, says Michael Hochman, M.D., director of the Gehr Family Center for Health Systems Science and Innovation at Keck Medicine of USC in Los Angeles.
If you think you have a respiratory infection, rest, drink plenty of fluids to prevent dehydration, and take the over-the-counter pain reliever acetaminophen (Tylenol and others) every 4 to 6 hours as needed to relieve headache, body aches, and fever (just don’t take more than 3,000 mg per day).
Acetaminophen is usually safer than a nonsteroidal anti-inflammatory—ibuprofen (Advil and others) or naproxen (Aleve and others)—Hochman says, because older adults are more vulnerable to side effects, such as stomach bleeding. Saline nasal spray can also help ease runny nose and congestion.
As for over-the-counter (OTC) cough and cold medicines, read labels carefully. Some contain antihistamines such as diphenhydramine, which the American Geriatrics Society doesn’t recommend for older adults because these have been linked to dry mouth, blurry vision, constipation, dizziness, and trouble urinating.
They also haven’t been shown to ease cold symptoms, according to a 2015 Cochrane review of research, and can cause sleepiness and other side effects.
Consider 1 to 2 teaspoons of honey every couple of hours instead, Hochman says. A 2018 Cochrane review found that it was just as effective, at least in kids, as dextromethorphan, an ingredient in many OTC cough medicines.
Call your doctor: If you have shortness of breath, confusion, lightheadedness, difficulty staying hydrated, or a persistent fever higher than 103° F, Hochman says. These symptoms may indicate COVID-19, and older adults are more likely to develop serious complications from the disease. (Up to 70 percent of adults older than 85 and 59 percent of those between 65 and 84 with COVID-19 end up admitted to the hospital, according to the Centers for Disease Control and Prevention.) Call again if your cough or fever worsens, or doesn’t ease after about 72 hours.
Seek emergency care: If you have trouble breathing, experience persistent chest pain or pressure, feel confused, or notice that your face or lips are turning blue. These may be signs of complications such as pneumonia.
Upset Stomach
Rates of food poisoning rise in warmer weather, when bacteria in food grow faster, according to the CDC.
It’s hard to know for certain whether it’s bad mayo or a gastrointestinal bug that’s causing nausea, vomiting, and/or diarrhea, but the treatment for both is essentially the same, says Kathryn Boling, M.D., a family medicine physician at Mercy Medical Center in Baltimore.
Either way, it’s important to take the proper steps: Older adults account for about 40 percent of all hospitalizations and 90 percent of all deaths from the common norovirus gastrointestinal bug, according to a 2017 CDC study in the journal Infectious Disease Clinics of North America.
So get plenty of fluids, and consider an oral rehydration solution like Pedialyte, because you may be losing salt and other nutrients, Hochman says. (If you can’t drink without vomiting or diarrhea, sip small amounts throughout the day.)
Skip anti-diarrheal medications such as loperamide (Imodium and generic) without first checking with your doctor, because the movement of stool through your gastrointestinal tract is often the way your body gets rid of toxins, he says. If you’re able to eat, focus on BRAT foods: bananas, rice, applesauce, and toast.
Call your doctor: If you have diarrhea and fever, severe abdominal pain, or blood or mucus in your stool, according to the Infectious Diseases Society of America. The doctor will probably have you collect a stool sample and send it to a lab for testing, to help determine whether the symptoms are caused by a virus or bacteria. You should also call if diarrhea doesn’t subside after about 48 hours.
Seek emergency care: If you notice signs of dehydration, such as very dark-colored urine, muscle cramps, fatigue, confusion, and dizziness when you stand up. “We have a lower threshold for sending older adults to the emergency room, since they’re more likely to become dehydrated,” Boling says.
Burns
Grilling season can quickly turn into burn season, but it can be tough to know when you can safely treat a burn at home and when you need to get it checked out by your doctor.
“Older adults are more prone to health complications from burns, both because their skin is more fragile, so a burn can cause more damage, as well as the fact that a burn can temporarily raise blood pressure, which stresses both the heart and the kidneys,” says Noelani Gonzalez, M.D., a dermatologist at Mount Sinai Hospital in New York City.
The first thing to do is wash the burn gently with cool tap water and plain soap, Fertel says. (Don’t use alcohol or iodine, which will increase discomfort, or smear on butter, which can worsen a burn.)
Then apply a cool cloth to the area, or soak it in cool water. Once the burn feels cool to the touch, cover it with a thick moisturizing ointment such as petroleum jelly and a bandage, Gonzalez says. (Skip OTC antibiotic creams such as bacitracin, which can provoke an allergic skin reaction in some people.)
Each day until the skin heals, wash the area with soap and water, and replace the bandage. Your skin may itch during healing; avoid the urge to scratch, which can damage skin. A nonprescription antihistamine like diphenhydramine (Benadryl and generic) may help with itchiness.
Call your doctor: If you’re older that 70, even if the burn seems mild. This is because age brings thinner skin and decreased sensation, which may mean the burn is more serious than you initially think it is, Fertel says. Your doctor can ask you specific questions and even have you email a photo of the burn to determine whether you need to be seen. He or she can also monitor you for signs of skin infection, such as increased redness, pain, pus, or a fever greater than 100.4° F. Call immediately if you notice any signs of blistering.
Seek emergency care: If the burn doesn’t hurt; the burn is waxy white, leathery gray, or a charred black color; and the burned skin fails to turn white when it’s touched. This could be a third- or fourth-degree burn, Gonzalez says, and probably will not heal without immediate treatment.
Cuts and Scrapes
“Anecdotally, we’re seeing a lot of first-aid injuries now, such as cuts, due to people being stuck at home,” Fertel says. “Everyone’s now pretending to be a gourmet chef or master gardener.”
But because older adults have weaker immune systems, they’re more prone to infections after a skin injury, especially if they have an underlying condition such as type 2 diabetes, Hochman says.
For a minor cut or scrape, wash it gently but well with soap and water. Skip hydrogen peroxide. “It won’t clean it any better than regular soap and water, and it will cause you a lot of pain,” Fertel says.
If it’s bleeding, press a clean cloth or bandage firmly on the area for about 10 minutes. Then apply a thin layer of OTC antibiotic ointment, and cover with a bandage or gauze. Change it once or twice a day until the cut heals. As the scab forms, leave it alone and don’t pick at it.
Call your doctor: If you notice signs of infection, such as fever, redness, swelling, warmth, increased pain, or even red streaks around the injury. Also call if you haven’t had a tetanus shot in the past five years—you may need a booster.
Seek emergency care: If bleeding does not stop within 10 minutes of continuous pressure, Boling says. Do the same if the cut is deep enough to expose the yellowish fatty tissue under your skin, jagged, or so wide that you can’t easily press the edges together with gentle pressure—you probably need stitches, Fertel says.
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Insect Bites and Stings
Wash the bite or sting with soap and water, then apply a cold compress—a cold, damp washcloth or damp cloth wrapped around an ice pack—to the area.
“If the stinger is still in there, I tell patients to scrape over the area with a credit card to dislodge it, because if you use tweezers, you can pump venom back into the area,” Boling says.
If you have meat tenderizer in your house, slap some on. “It helps break down protein, and the venom in bug bites and stings is protein-based, so you won’t get as bad of a reaction,” she says.
An OTC antihistamine such as diphenhydramine (Benadryl) or cetirizine (Zyrtec) can ease any itching, and an OTC pain reliever such as ibuprofen (Advil and generic) may reduce swelling and pain.
Found a tick on your body but unsure whether you’ve been bitten? Remove the tick safely and regularly check the area of your body where you found the tick for several weeks after removal for rash.
Call your doctor: If any redness, pain, and swelling doesn’t begin resolving—or gets worse—after about 48 to 72 hours, see your doctor to make sure it’s not infected. In the several weeks after a possible tick bite, call your doctor if you develop a fever, or a rash near where you removed the critter. You may need to be tested for Lyme and other tick-borne diseases.
Seek emergency care: If you develop symptoms of a severe allergic reaction (anaphylaxis), such as trouble breathing, tightness of the throat, hoarse voice, nausea, and vomiting.
Sprains and Strains
“The older we get, the less flexible we become, and the range of motion around our joints sometimes diminishes due to arthritis,” says Craig Tifford, M.D., assistant professor of clinical orthopaedics at the Yale School of Medicine. As a result, injuries can take longer to heal.
If you think you strained or sprained your ankle, knee, back, or wrist, it can usually be taken care of with RICE (rest, ice, compression, and elevation), says Sindhu Kurian Aderson, M.D., an immediate care center physician at Northwestern Medicine in Chicago.
Start with icing. “I tell patients that if they have a bag of frozen peas, use that because those tiny balls can fit into crevices that a traditional ice pack can’t reach,” she says. Apply for 10 minutes several times a day. To prevent additional swelling, use an elastic compression bandage. (Pantyhose can work in a pinch, Boling says.)
Stay off the affected area, if possible, and elevate it above the level of your heart—especially when asleep—to help gravity reduce swelling, for about 72 hours. Don’t use a heating pad. “It dilates blood vessels, which can increase swelling,” Tifford says.
An OTC anti-inflammatory such as ibuprofen (Advil and others) or naproxen (Aleve and others) can also help relieve pain and swelling.
Call your doctor: If symptoms don’t begin to ease within 72 hours, or get worse, Tifford says. This may indicate that you have a fracture, not just a sprain.
Some cases may be able to be handled via telemedicine. “There’s a secret that many of us in medicine have known for many years—something called the Ottawa foot and ankle rules,” Fertel says.
Your doctor may be able to virtually walk you through this test, which calls for pressing on certain spots to help determine whether you may have broken a bone. If you “fail,” you’ll need to go get an X-ray.
Seek emergency care: If the area looks deformed, you see a bone protruding through the skin, or you have a loss of sensation around the injury. You need an X-ray to make sure you don’t have a fracture, Tifford says. If you live near an orthopedic urgent care center, or an urgent care center with an X-ray machine, Tifford recommends going there first, because these are likely to be less crowded than an ER.
What Your First-Aid Kit Should Contain
Now more than ever, a home first-aid kit is essential. The American Red Cross recommends:
1. Absorbent compress dressings to help stop severe bleeding.
2. Adhesive cloth tape to hold compress dressings in place.
3. Adhesive bandages of assorted sizes.
4. Antibiotic ointment, such as bacitracin, polysporin, or mupirocin.
5. Antiseptic solution or wipes, such as hydrogen peroxide, povidone-iodine, or chlorhexidine.
6. Aspirin in the event of a heart attack.
7. Instant cold compress.
8. Nonlatex gloves.
9. Hydrocortisone ointment.
10. Gauze roll bandages (3- and 4-inch) to wrap injuries.
11. Box of sterile gauze pads for sterile wound dressings.
12. Triangular bandage to use as a bandage or tourniquet.
13. Oral thermometer.
14. Tweezers.
15. CPR mask, which can be used to administer CPR without breathing in another person’s bodily fluids.
You may also want to have petroleum jelly, pain relievers such as acetaminophen (Tylenol and generic), and antihistamines like diphenhydramine (Benadryl and generic). Be alert for side effects with antihistamines.
Note: Because COVID-19 can cause low blood oxygen, you may be wondering whether you should have a home pulse oximeter, a device typically worn on the finger to check levels of oxygen in the blood.
If you decide to purchase one, note that a 2016 study found that some home models were more error-prone than oximeters that doctors use. And if you have symptoms that could be COVID-19, pay attention for shortness of breath, and alert your doctor right away if it occurs.
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