Two injuries where the window is measured in minutes to hours, and where the instinctive action is usually the wrong one.
Dental injuries
Time-critical in a way that surprises people, and handled wrongly more often than not.
| Injury | What to do |
|---|---|
| Knocked-out adult tooth | Hold it by the crown, never the root — the root surface carries the cells that let it reattach, and wiping them off is what loses the tooth. Rinse briefly in milk or saline if it is dirty, never scrub. Put it straight back in the socket if you can, the right way round, and have them bite gently on a cloth to hold it. If you cannot, store it in milk — or saliva, inside their own cheek if they are old enough not to swallow it. Not water, which damages the cells. Then a dentist within the hour: reimplantation success falls sharply with every ten minutes out of the mouth |
| Knocked-out baby tooth | Do not put it back. Reimplanting a milk tooth can damage the developing adult tooth underneath. Control the bleeding with gauze and see a dentist |
| Broken or chipped tooth | Keep any fragment in milk. Dentist promptly — an exposed nerve is both painful and an infection route |
| Loosened or pushed-out-of-position tooth | Do not force it back. Soft diet, dentist the same day |
| Bleeding socket or gum | Firm pressure with rolled gauze, biting down, for ten minutes without checking. Avoid rinsing, which dislodges the clot |
| Suspected jaw fracture | Support the jaw, do not try to test the bite, and go to an emergency department rather than a dentist |
And the reason a knocked-out tooth belongs in an emergency reference at all: the window is measured in tens of minutes, the correct handling is counterintuitive, and the wrong handling — scrubbing the root, storing it in water, or wrapping it in a tissue — is what most people do. A tooth held by the crown and dropped into milk is very often saveable an hour later.
Eye injuries
The eye is the one place where the first two minutes are often the whole treatment, and where the reflex to inspect the damage does the damage.
Chemical splash — irrigate before anything else
- Start immediately and do not stop to find sterile fluid. Tap water, a shower, a bottle of water — whatever reaches the eye in the next ten seconds. Time matters more than the fluid.
- At least 20 minutes of continuous irrigation, and continue on the way to hospital. Hold the eyelids open — they will clamp shut, and the fluid must reach under them.
- Run the water away from the unaffected eye, not across it.
- Alkalis are worse than acids — oven cleaner, drain cleaner, cement, plaster and lime keep penetrating after the initial contact. Cement dust in an eye is a genuine emergency and is regularly treated as trivial.
- Take the container. And go to an emergency department every time, however comfortable the eye feels afterwards.
| Situation | What to do |
|---|---|
| Loose grit or an eyelash | Irrigate. Blink under water. If it does not shift with irrigation, stop and get it looked at rather than persisting |
| Something embedded, or a penetrating injury | Do not remove it, do not press, do not irrigate. Cover both eyes if you can — the eyes move together, so covering only the injured one does not rest it — keep them sitting up, and go straight to hospital |
| High-speed fragment — grinding, hammering, strimming | Assume penetration even if the eye looks normal and feels fine. A tiny metal fragment can enter with almost no sign. Emergency department, and say what they were doing |
| Blunt injury — ball, fist, elbow | Cold compress around the eye rather than on it. Hospital for any change in vision, blood visible in the front of the eye, an irregular pupil, or pain on eye movement |
| Welding or sunlamp flash | Painful several hours later, both eyes, gritty. Uncomfortable rather than dangerous, but it needs assessment |
| Contact lens in place | Remove it if you can do so easily, except after a penetrating injury or a chemical splash where irrigation comes first |
Any change in vision after any eye injury is a hospital visit, including a shadow, a curtain, flashes, a sudden shower of floaters, or double vision. Sight lost through delay is rarely recovered, and the eye is unusually poor at signalling how much trouble it is in.
Chemical burns are the exception to almost everything above. Brush off any dry powder first, then irrigate with running water for far longer — at least 20 minutes and often much more, continuing on the way to hospital. Do not try to neutralise an acid with an alkali or the reverse; the reaction generates heat and makes it worse. Take the container or a photograph of the label.