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first aid

first aid, immediate and temporary treatment of a victim of sudden illness or injury while awaiting the arrival of medical aid. Proper early measures may be instrumental in saving life and ensuring a better and more rapid recovery. The avoidance of unnecessary movement and over-excitation of the victim often prevents further injury. Conditions that require immediate attention to avert death include cessation of breathing (asphyxia), severe bleeding, poisoning, strokes, and heart attack. The essentials of first aid treatment also include the correct bandaging of a wound; the application of splints for fractures and dislocations; the effective methods of cardiopulmonary resuscitation (CPR) and artificial respiration; and treatment of shock, frostbite, fainting, bites and stings, burns, and heat exhaustion.

Asphyxia and Obstruction of Air Passages

Symptoms: Blue discoloration of face, tongue, and lips; gasping; inability to speak; unconsciousness. Treatment: First try the Heimlich maneuver, grasping the victim from behind with hands linked in front and compressing the abdomen just below the ribs. Encourage victim to cough up foreign objects in throat; as a last resort, rap victim between shoulder blades to dislodge object. For asphyxia caused by gas or fumes, remove victim to a clear atmosphere; use artificial respiration.

Bites and Stings

Symptoms: Wound (animal or human bite) or swelling and pain (insect sting). Treatment: For animal and human bites, cleanse wound with soap and water and apply iodine containing antiseptic; submit animal for rabies test. For poisonous snakebite, cooling the site of the wound with ice will slow down absorption of poisons; antivenin treatment is required only for a small number of reptile bites. Prevent exertion and taking of stimulants by victim. For insect stings apply cortisone ointments, soothing lotions, or cool compress. Persons who are allergic to insect stings should carry adrenaline with them at all times. Papain, the main ingredient in "meat tenderizer," is effective in coral sting injuries.

Burns

Symptoms: Redness (first-degree burns), blistering (second-degree burns), charring of skin (third-degree burns). Treatment: Cold water may be applied to first- and second-degree burns. All burns should be covered with sterile non-adherent dressings. Chemical burns should be washed with large quantity of water; vinegar may be added to the water for alkali burns, and sodium bicarbonate may be added to the water in case of acid burns.

Drowning and Near-Drowning

Treatment: Immediate artificial respiration, and CPR. There is controversy over whether or not the Heimlich maneuver should be used in conjunction with CPR in order to dislodge water in the lungs and stomach.

Fainting

Symptoms: Unconsciousness, paleness, rapid pulse, coldness of the skin, sweating. Treatment: Leave victim lying down, loosen clothing, roll victim to the side and wipe out mouth in the event of vomiting.

Foreign Body in the Eye

Symptoms: Pain, redness, burning, tears. Treatment: Pull down lower lid and remove unembedded object with clean tissue if it lies on the inner surface of lower lid. If object has not been located, pull upper lid forward and down over lower lid. Object can be removed from surface of upper eyelid by turning lid back over a swabstick or similar object and lifting off the foreign body with a clean tissue. Finally, flush the eye with water. If object is suspected to be embedded, apply a dry, protective dressing over eye, and call physician or take patient to hospital emergency room. Keep victim from rubbing the eye. For chemical burns, flood eyes with water.

Fractures and Joint Injuries

Symptoms: Pain or tenderness, deformity of bones, swelling, discoloration. Treatment: Prevent movement of injured parts until splint is applied; treat for shock; if ambulance service is not available, splint entire limb before moving. For sprains, elevate affected part and apply cold compresses. Elastic bandages may be used for immobilization.

Frostbite

Symptoms: Numbness, pale, glossy skin, possible blistering. Treatment: Warm by placing victim indoors, remove covering, bathe frozen part in warm water; do not massage. For cold exposure, give artificial respiration. Placing blankets over a person who has a reduced body core temperature will do no good; heat must be applied to the victim to bring the temperature up to normal. If conscious, give warm liquids by mouth.

Heat Exhaustion

Symptoms: Pale, clammy skin, profuse perspiration, weakness, headache, possibly cramps. Treatment: Rest, cool atmosphere, cool water by mouth if conscious. In case of heat cramp, exert firm pressure on cramped muscle (usually abdomen or legs) to help relieve spasms.

Heatstroke

Symptoms: High temperature (as high as 108–112°F/42–44°C), hot dry skin, rapid pulse, possibly unconsciousness. Treatment: Immediately undress victim and sponge with or immerse in cool water or wrap in water-soaked sheets. Use fan or air conditioner.

Poisoning

Symptoms and signs: Information from victim or observer, stains about mouth, presence of poison container, breath odor, pupils contracted to pinpoint size from morphine or narcotics. Treatment: Dilute ingested poison by administering water or milk, administer specific antidote if described on label of commercial product. Do not induce vomiting if poison is strong acid, strong alkali, or petroleum product, or if victim is unconscious or convulsive. Syrup of Ipecac available without prescription at pharmacies may be administered to induce vomiting in other cases. A universal antidote contains Ipecac and activated charcoal; the latter absorbs the poison and the former causes it to be expelled.

Severe Bleeding

Symptoms: External wound. Treatment: Apply pressure over wound with wad of sterile gauze or other clean material. If bleeding continues and no fracture is present, elevate wound. If bleeding still continues, apply pressure to blood vessels leading to area—in arm, press just below armpit; in leg, press against groin where thigh and trunk join. Use a tourniquet (tight band that cuts off circulation) only when it has been decided that the sacrifice of a limb is necessary to save life.

Shock

Symptoms: Pale (or bluish) skin (in victim with dark skin examine inside of mouth and nailbeds for bluish coloration), cool skin, weakness, weak pulse; unresponsiveness and dilated pupils in later stages. Treatment: Keep victim lying down and covered enough to prevent loss of body heat. The body position should be adjusted according to the victim's injuries. Victims in shock may improve if the feet are raised 8 to 12 in. (20–30 cm). For electric shock, cut off current or separate victim from contact with electricity by using dry wood, rope, cloth, or rubber; administer CPR.

Wound

Treatment: Stop bleeding, cleanse wound with soap and water and cover with sterile or clean bandage.

Bibliography

See Red Cross literature for a complete description of first aid techniques.

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first aid

first aid Action taken by anyone encountering sudden illness or injury in order to save life, mitigate harm or assist subsequent treatment. Properly administered first aid can save lives and improve the extent and speed of recovery. If the victim appears to have a broken bone or internal injuries, they should not be moved. If the victim is unconscious, their head should be turned to one side to prevent choking. Check that the victim has an open airway – if not, they may have respiratory failure (asphyxia). Asphyxia may be caused by the obstruction of air passages, in which case the Heimlich manoeuvre is recommended. For asphyxia caused by fumes or gas, such as carbon monoxide, the victim should be moved to a clear atmosphere before administering artificial respiration. The best method of artifical respiration is mouth-to-mouth resuscitation. Place the victim on their back, put one hand under the victim's chin and the other on the forehead. Tilt the victim's head back by lifting with the hand under the chin and pressing down on the forehead. If the victim is a child, take a breath, place your mouth over both the nose and mouth, and blow gently. Remove your mouth and listen for air entering the child's lungs. Take a breath and repeat every three seconds until the child begins to breathe. If the victim is an adult, pinch the nostrils shut, take a deep breath, cover the mouth tightly and breathe hard. Repeat this procedure every five seconds. If the victim has swallowed a poisonous substance, identify the poison and then call the emergency services. They may recommend inducing vomiting with syrup of ipecac. In the case of animal bites and stings, the wound should be cleaned with soap and water before applying antiseptic and a bandage. For poisonous snakebite, the wound should be cooled with ice to slow down the absorption of poison. A few snakebites require anti-venoms. In order to stop the victim bleeding severly, apply direct pressure preferably with a sterile dressing. If bleeding continues, apply pressure to the artery that supplies blood to the area. To treat shock, place the victim on their back with their legs raised slightly, and place a blanket over the body to prevent heat loss. In the case of first- and second-degree burns, cold water should be applied before dressing with sterile bandages.

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first aid

first aid • n. help given to a sick or injured person until full medical treatment is available: an expert in emergency first aid [as adj.] a first-aid kit. DERIVATIVES: first aid·er / ˈādər/ n.

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first aid

first aid (ferst) n. procedures used in an emergency to help a wounded or ill patient before the arrival of a doctor or admission to hospital.
www.sja.org.uk St John's Ambulance website

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First Aid

First Aid

Definition

First aid is the initial basic treatment of an injured or ill person. First aid requires an observer first to evaluate the injured or ill person and then to intervene, using a small amount of supplies.

Purpose

First aid is provided to a person immediately following an accident or onset of illness to decrease complications and to offer psychological (emotional) and physical comfort. It is performed to decrease the individual's pain and suffering until emergency medical technicians (EMTs) or other health care givers arrive on the scene.

Precautions

The provision of first aid should never postpone the initial contact with the emergency medical system. The bystander should wear disposable latex gloves if available, in case of contact with blood or body fluids. If gloves are not available, plastic bags or wrap can be used as a protective barrier.

Description

First aid is a universal term that encompasses many general concepts for rapid assessment of health crises and intervention. The following sections present the most common injuries and illnesses requiring first aid, and the interventions appropriate in these situations.

Changes in mental status

ASSESSMENT. With any sudden changes in a person's brain functioning, first aid should start immediately. Assess the person for:

  • unconsciousness
  • lightheadedness
  • weakness on one side of body
  • aggressiveness
  • confused state
  • changes in orientation
  • headache
  • blurred or double vision
  • unsteady balance

INTERVENTION. Initiate cardiopulmonary resuscitation (CPR) if the person is not breathing. Secure the area around the person by removing any potential hazards, and maintain a favorable environment by providing an adequate area ventilation and room temperature. The person should be placed in a side-lying position.

Bleeding (hemorrhage)

ASSESSMENT. Assessing an injured person for bleeding must be done promptly, with first aid started immediately if there is active bleeding. All blood and body fluids must be regarded as potentially infectious, and protective barriers used.

INTERVENTION. Direct pressure should be applied to the hemorrhaging (bleeding) area by placing a clean pad or bandage over the site and pressing down with the palm of the hand. If bleeding persists, increase the amount of pressure to the area. If the person is awake and no latex gloves or other protective barriers are available, have him or her apply direct steady pressure to the hemorrhaging area. If the bleeding occurs on an arm or leg, elevate the bleeding part higher than the person's heart; this will help decrease the amount of blood flow to the injured area. When a person is losing blood, body temperature tends to decrease. Maintaining body temperature is an essential first-aid intervention.

Poisoning: inhalation, ingestion, or exposure

ASSESSMENT. Initial evaluation of a poison victim is done after the threat of exposure to the rescuer is determined. If a noxious gas or fumes remain in the environment, the rescuer must first protect him- or herself and others. The rescuer must move the person to a secure environment as promptly as possible to start first aid.

INTERVENTION. The first and most important intervention is to call a poison control center and get instructions on how to proceed. Having information on the type of poison ingested, if possible, as well as reading the label over the phone or spelling out the active ingredients on the bottle, will help the poison control center in determining the appropriate interventions. The rescuer must never induce vomiting or give any substance unless directed by the poison control center.

Burns

ASSESSMENT. Burns are categorized by the extent of damage to the skin or underlying tissue. First-degree burns are the least critical; they cause reddening of the skin without blistering. Second-degree burns cause damage to the superficial (outer) and the internal (inner) layers of skin, creating bubble-like sores (blisters) that contain clear, watery liquid. Third-degree burns are the most severe and most damaging of all burns; the destruction of all layers of skin occurs and the burnt area is left open and charred. When applying first-aid concepts to burns, the rescuer must quickly assess the extent of damage to the person's skin. The rescuer needs to determine through assessment what to do next.

INTERVENTION. First-degree burns can usually be treated at home with a sterile burn gel, and complete healing should take place within one week. A person with a second-degree burn greater than the size of his or her palm should seek medical treatment, or if the burn is in a sensitive area like the groin. Third-degree burns need medical attention immediately. Ice application is not recommended for severe burns because ice can cause trauma to the area. Cool to lukewarm water is recommended. The burn victim must be covered, preferably with clean blankets, in order to maintain a normal body temperature.

Head/neck injuries

ASSESSMENT. It is vital for the rescuer to determine the nature of the head/neck injury, as well as if the person has had any loss of consciousness. This information should be conveyed to the emergency medical responders to help determine the need for further testing.

INTERVENTION. It is important to limit the movement of the victim of a head or neck injury, because it could result in more damage. Do not move the head or neck unless absolutely necessary—for example, if vomiting starts. In such a situation, the rescuer must carefully turn the person to the side in order to prevent inhalation of vomit into the lungs.

Seizure

ASSESSMENT. A seizure occurs when the brain emits irregular electrical signals. The person having a seizure usually falls to the ground and shakes. The person may lose urinary or bowel functioning.

INTERVENTION. It is important to clear a safe area for a seizure victim. Protecting the skull with a cushion or blanket will help decrease injuries to the head and neck. The rescuer should never restrain the victim or put anything in the mouth. When the seizure stops, place the victim in a side-lying position to avoid the breathing in of mucus and other secretions.

Muscle/bone injuries

ASSESSMENT. When there have been muscle or bone injuries, the person initiating first aid should assume that the arm or the leg is broken.

INTERVENTION. If the arm or leg appears misshapen, the rescuer should not try to align it. The rescuer wants to stabilize the injured body part in order to protect it from further injury. Ice application can reduce swelling and pain. Heat should not be used, because it increases circulation to the injured site.

Preparation

A first-aid kit can have a variety of equipment in it. The basic items should include:

  • ace bandages in a variety of sizes
  • antibiotic ointment
  • latex gloves
  • a protective barrier/shield for use in CPR
  • sterile gauze pads and wraps in a variety of sizes
  • sealed alcohol packets
  • scissors
  • tape
  • tweezers

Aftercare

The care needed after first aid varies widely, depending on the type of injury or illness sustained. Health care professionals are excellent resources to consult about appropriate individualized aftercare.

Complications

Many unexpected complications can happen while providing first aid. The most severe complication is if the patient stops breathing or the heart stops beating. In such a situation, the rescuer should immediately start CPR.

Results

The results of first aid vary with the case. Successful first aid results in the improved health and recovery of the patient.

Health care team roles

All health care professionals have a professional obligation to know the basics of first aid. Accidental injuries account for 2.6 million hospital admissions annually. Unplanned injury is the fifth-leading cause of fatalities in the United States.

Patient education

Health care professionals are in a position that allows them to provide education about first aid to patients. Emphasis on the importance of having a first-aid kit available and well stocked is valuable information to pass on to patients. Information about local areas that offer first-aid training should be offered.

Training

Extensive training is not needed for first aid. The Occupational Safety and Health Administration (OSHA) advises that retraining in first aid should occur every three years.

Good Samaritan Law

Legally, health care professionals coming to a person's aid in an emergency situation are covered under the federal Good Samaritan Law. Protection under this law requires that the situation is deemed an emergency, that no monetary compensation for the treatment is provided, and that the care provided is done "in good faith." In most U.S. states, health care professionals have no mandatory obligation to help in an emergency situation, but the Good Samaritan Law is in place to protect from liability those who do offer assistance.

KEY TERMS

Emergency medical technician (EMT)— A person who is trained and certified to provide basic life support.

Hemorrhage— To be actively bleeding.

Superficial— A term meaning outermost or not deep.

Resources

PERIODICALS

American Heart Association. "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 5: New Guidelines for First Aid." Circulation 102 (August 22, 2000): 77-85.

Brown, S. M. "Good Samaritan Laws: Protection and Limits." RN 62 (November 1999): 65-67.

Fiske, S. "Why Employees Need First Aid Training." Occupational Hazards 61 (February 1999): 55-57.

OTHER

Fuerst, R. "First Aid Kit Preparation from AAEM Emergency Medical and Family Health Guide: Public Health." eMedicine.com 2001. 〈http://www.emedicine.com/aaem/topic205.htm〉 (April 1, 2001).

Levin, H. "Burns from Consumer Treatment Guidelines: Injury and Wound Problems." eMedicine.com 2000. 〈http://www.emedicine.com/general/topic24.htm〉 (November 30, 2000).

Plantz, S. H. "Seizures from Wilderness Emergencies: Medical Disorders." eMedicine.com 2000. 〈http://www.emedicine.com/wild/topic48.htm〉 (February 9, 2000).

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First Aid

First aid

Definition

First aid is the initial basic treatment of an injured or ill person. First aid requires an observer first to evaluate the injured or ill person and then to intervene, using a small amount of supplies.

Purpose

First aid is provided to a person immediately following an accident or onset of illness to decrease complications and to offer psychological (emotional) and physical comfort. It is performed to decrease the individual's pain and suffering until emergency medical technicians (EMTs) or other health care givers arrive on the scene.

Precautions

The provision of first aid should never postpone the initial contact with the emergency medical system. The bystander should wear disposable latex gloves if available, in case of contact with blood or body fluids. If gloves are not available, plastic bags or wrap can be used as a protective barrier.

Description

First aid is a universal term that encompasses many general concepts for rapid assessment of health crises and intervention. The following sections present the most common injuries and illnesses requiring first aid, and the interventions appropriate in these situations.

Changes in mental status

ASSESSMENT. With any sudden changes in a person's brain functioning, first aid should start immediately. Assess the person for:

  • unconsciousness
  • lightheadedness
  • weakness on one side of body
  • aggressiveness
  • confused state
  • changes in orientation
  • headache
  • blurred or double vision
  • unsteady balance

INTERVENTION. Initiate cardiopulmonary resuscitation (CPR ) if the person is not breathing. Secure the area around the person by removing any potential hazards, and maintain a favorable environment by providing an adequate area ventilation and room temperature. The person should be placed in a side-lying position.

Bleeding (hemorrhage)

ASSESSMENT. Assessing an injured person for bleeding must be done promptly, with first aid started immediately if there is active bleeding. All blood and body fluids must be regarded as potentially infectious, and protective barriers used.

INTERVENTION. Direct pressure should be applied to the hemorrhaging (bleeding) area by placing a clean pad or bandage over the site and pressing down with the palm of the hand. If bleeding persists, increase the amount of pressure to the area. If the person is awake and no latex gloves or other protective barriers are available, have him or her apply direct steady pressure to the hemorrhaging area. If the bleeding occurs on an arm or leg, elevate the bleeding part higher than the person's heart ; this position will help decrease the amount of blood flow to the injured area. When a person is losing blood, body temperature tends to decrease. Maintaining body temperature is an essential first-aid intervention.

Poisoning: inhalation, ingestion, or exposure

ASSESSMENT. Initial evaluation of a poison victim is done after the threat of exposure to the rescuer is determined. If noxious gas or fumes remain in the environment, the rescuer must first protect him-or herself and others. The rescuer must move the person to a secure environment as promptly as possible to start first aid.

INTERVENTION. The first and most important intervention is to call a poison control center and get instructions on how to proceed. Having information on the type of poison ingested, if possible, as well as reading the label over the phone or spelling out the active ingredients on the bottle, will help the poison control center in determining the appropriate interventions. The rescuer must never induce vomiting or give any substance unless directed by the poison control center.

Burns

ASSESSMENT. Burns are categorized by the extent of damage to the skin or underlying tissue. First-degree burns are the least critical; they cause reddening of the skin without blistering. Second-degree burns cause damage to the superficial (outer) and the internal (inner) layers of skin, creating bubble-like sores (blisters) that contain clear, watery liquid. Third-degree burns are the most severe and most damaging of all burns; the destruction of all layers of skin occurs and the burnt area is left open and charred. When applying first-aid concepts to burns, the rescuer must quickly assess the extent of damage to the person's skin. The rescuer needs to determine through assessment what to do next.

INTERVENTION. First-degree burns can usually be treated at home with a sterile burn gel, and complete healing should take place within one week. A person with a second-degree burn greater than the size of his or her palm should seek medical treatment, or if the burn is in a sensitive area like the groin. Third-degree burns need medical attention immediately. Ice application is not recommended for severe burns because ice can cause trauma to the area. Cool to lukewarm water is recommended. The burn victim must be covered, preferably with clean blankets, in order to maintain a normal body temperature.

Head/neck injuries

ASSESSMENT. It is vital for the rescuer to determine the nature of the head/neck injury, as well as if the person has had any loss of consciousness. This information should be conveyed to the emergency medical responders to help determine the need for further testing.

INTERVENTION. It is important to limit the movement of the victim of a head or neck injury, because it could result in more damage. Do not move the head or neck unless absolutely necessary—for example, if vomiting starts. In such a situation, the rescuer must carefully turn the person to the side in order to prevent inhalation of vomit into the lungs .

Seizure

ASSESSMENT. A seizure occurs when the brain emits irregular electrical signals. The person having a seizure usually falls to the ground and shakes. The person may lose urinary or bowel functioning.

INTERVENTION. It is important to clear a safe area for a seizure victim. Protecting the skull with a cushion or blanket will help decrease injuries to the head and neck. The rescuer should never restrain the victim or put anything in the mouth. When the seizure stops, place the


KEY TERMS


Emergency medical technician (EMT) —A person who is trained and certified to provide basic life support.

Hemorrhage —To be actively bleeding.

Superficial —A term meaning outermost or not deep.


victim in a side-lying position to avoid the breathing in of mucus and other secretions.

Muscle/bone injuries

ASSESSMENT. When there have been muscle or bone injuries, the person initiating first aid should assume that the arm or the leg is broken.

INTERVENTION. If the arm or leg appears misshapen, the rescuer should not try to align it. The rescuer wants to stabilize the injured body part in order to protect it from further injury. Ice application can reduce swelling and pain. Heat should not be used, because it increases circulation to the injured site.

Preparation

A first-aid kit can have a variety of equipment in it.

The basic items should include:

  • ace bandages in a variety of sizes
  • antibiotic ointment
  • latex gloves
  • a protective barrier/shield for use in CPR
  • sterile gauze pads and wraps in a variety of sizes
  • sealed alcohol packets
  • scissors
  • tape
  • tweezers

Aftercare

The care needed after first aid varies widely, depending on the type of injury or illness sustained. Health care professionals are excellent resources to consult about appropriate individualized aftercare.

Complications

Many unexpected complications can happen while providing first aid. The most severe complication is if the patient stops breathing or the heart stops beating. In such a situation, the rescuer should immediately start CPR.

Results

The results of first aid vary with the case. Successful first aid results in the improved health and recovery of the patient.

Health care team roles

All health care professionals have a professional obligation to know the basics of first aid. Accidental injuries account for 2.6 million hospital admissions annually. Unplanned injury is the fifth-leading cause of fatalities in the United States.

Patient education

Health care professionals are in a position that allows them to provide education about first aid to patients. Emphasis on the importance of having a first-aid kit available and well stocked is valuable information to pass on to patients. Information about local areas that offer first-aid training should be offered.

Training

Extensive training is not needed for first aid. The Occupational Safety and Health Administration (OSHA) advises that retraining in first aid should occur every three years.

Good Samaritan Law

Legally, health care professionals coming to a person's aid in an emergency situation are covered under the federal Good Samaritan Law. Protection under this law requires that the situation is deemed an emergency, that no monetary compensation for the treatment is provided, and that the care provided is done "in good faith." In most U.S. states, health care professionals have no mandatory obligation to help in an emergency situation, but the Good Samaritan Law is in place to protect from liability those who do offer assistance.

Resources

PERIODICALS

American Heart Association. "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 5: New Guidelines for First Aid." Circulation 102 (August 22, 2000): 77-85.

Brown, S. M. "Good Samaritan Laws: Protection and Limits." RN 62 (November 1999): 65-67.

Fiske, S. "Why Employees Need First Aid Training." Occupational Hazards 61 (February 1999): 55-57.

OTHER

Fuerst, R. "First Aid Kit Preparation from AAEM Emergency Medical and Family Health Guide: Public Health." eMedicine.com 2001. <http://www.emedicine.com/aaem/topic205.htm> (April 1, 2001).

Levin, H. "Burns from Consumer Treatment Guidelines: Injury and Wound Problems." eMedicine.com 2000. <http://www.emedicine.com/general/topic24.htm> (November 30, 2000).

Plantz, S. H. "Seizures from Wilderness Emergencies: Medical Disorders." eMedicine.com 2000. <http://www.emedicine.com/wild/topic48.htm> (February 9, 2000).

Lori Ann Beck, R.N., M.S.N., F.N.P.-C.

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