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El verano debe de ser un
tiempo para explorar sus
posibilidades y desarollar
su cuerpo y disfrutar, todo
tiene un riesgo, pero aun
las heridas pueden tener
un beneficio....... |
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llame al doctor cuando hay:
infeccion, herida profunda,
quemadura 3er grado, fractura con
herida |
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no todas las hierbas son anti
inflamatorias, hay que escojer bien |
Por todo el verano los ninos exploran, corren y muchas veces se cayen. Como se puede reparar una laceracion simple sin riesgo de infeccion, sin esperarse horas para ver un medico. La piel o tegumento es la mas efectiva defensa imunologica que tenemos contra la enfermedad. Una laceracion o pinchazo o quemadura de la piel la hace suseptible a infecciones. El cuidado correcto de las herdidas puede resultar en menos tiempo para curarse, puede evitar la infeccion, puede evitar el dano a la piel en si. En este pequeno resumen Uds veran los pasos necesarios para tratar el dolor, la curacion y el dano a la piel. Puede tambien ayudar en evitar un cicatriz grande.
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Esta cubre demasiado de la herida,
la proteja pero muchas veces
la deja con aun mas riesgo para
infeccion |
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Quizas la mejor
manera para empezar un
tratamiento de una laceracion |
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esta opcion funciona
para dejar la parte
central de la herida
abierta al aire |
LACERACION
1. Aplica presion direct a la herida o a la arteria mas cerca a la herida con una tela limpia
2. Eleva la parte que sangra arriba a la nivel del corazon para parar el flujo de la sangre
3. Aplica presion a los vasos entre la herida el el corazon, cuidado con aplicar demasiado presion porque el cuerpo tiene un mecanismo natural para cuajar la sangre. Las arterias son necesarias para ayudar con la curacion, y no se debe de oprimir esos vasos demasiado.
4. Al dejar de sangrar se pone algo frio para disminuir el flujo de la sangre al area. (Un panal enfriado con agua fria es suficiente).
5. Ahora se puede lavar el area con jabon y agua fria. Saca todo el polvo y todos los granitos o particulos. Puede ser necesario frotar el area suavemente para sacar todos los particulos, usando agua limpia o esteril o agua con salina. Si empieza a sangrar nuevamente, aplica presion directa con un panal limpia o gaza.
6. se puede aplicar un unguento antiinfectivo a la laceracion. Cuidadosamente pone las bordes de la herida cerca y pone una gaza esteril. Si usa un liquido adhesivo, evita un unguento porque no se va a adherir con tal aplicacion.
PINCHAZO
CUIDADO: no se usa unguento con pinchazo.
1. Se usa H2O2 a la herida, el uso de tal solucion atrae particulos finos de la herida, ademas es un aninfectivo. Hay que hacerlo 2 a 3 veces al dia. Si empeora, hay que ver el medico.
2. Cubrelo con gaza esteril y cambialo 2 a 3 veces al dia.
3. Para el dia 3 se debe de mejorary.
RAZGUNO
1. Limpialo bien
2. Dejalo al aire libre. Se puede usar un spray antiinfectivo, si se pone mas rojo, o si hay drenaje verde o amarillo se puede usar un unguento antiinfectivo y cubrirlo con una gaza esteril
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Muchos estudios muestran
beneficios contra la
infeccion |
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ALOE VERA: Mejor para prevenir ampollas
de quemaduras |
QUEMADURA
1. Solamente para quemaduras del primer o segundo grado.
2. PRIMERO:
Inmediatamente para la quemadura, si es quimico hay que neutralizar el quimico on agua fria (tibia para quimicas menos fuerte o si los ojos estan expuestos), por 15 minutos o hasta terminar completamente. Si no hay agua cerca, se puede aplicar gaza frias al area. Se deja el agua por 10 a 15 minutos, y cambiarlo. NO SE APLICA el hielo, porque puede aumentar el dano a la piel en vez de quitarlo.
3. Se puede aplicar "Aloe Vera: directamente a la quemadura para prevenir el desarollo de las ampollas. Un pedacito directo cortado de la planta es suficiente.
COSAS NATURALES QUE AYUDAN Y NO HACEN DANO:
1. La miel es antibacterial y antiinflamatorio. En un estudio en 2006, pequenas, quemaduras se sana mas rapidas con una gaza con miel que los con unguentos antibacteriales.
2. La mostaza reduce el dolor y las ampollas
3. Un pedazo de papa puede prevenir manchas y cicatrices
4. Lo blanco de un huevo puede reducir el dolor y prevenir manchas y cicatrices.
5. Otras posibilidades incluyen: te camomile, mint, lavendar oil, oatmeal
DEJA la quemadura al aire libre. Una ampolla formara dentro de 24 hors si tienen una quemadurea al segundo grado. Deja la apolla, se puede aplicar una benda liquida a la ampolla para que no se quibra
6. Si se abre la ampolla, ya tienen una herida abierta, y hay que lavarla con jabon y agua para prevenir infeccion.
7. Hay que tomar mucha agua, vitaminas como A,C,E,Zinc para ayudarla.
The skin is our first and most effective line of defense
against illness. When our skin is damaged due to a scrape, cut, puncture or
burn we are vulnerable to infection. Correct wound care is essential to
minimize healing time and avoid infection and worsening of the area of damaged
skin. This article will cover basic steps to care for minor skin injuries and
thereby promote healing. Good healing decreases the pain associated with
injuries to the skin and reduces the size and appearance of scarring afterward.
Control bleeding. Use
one or more of the following strategies.
o
Apply
direct pressure to the wound or to the artery within the closest proximity of
the wound with your hand and a clean cloth.
Apply direct pressure to the wound or to the artery within
the closest proximity of the wound with your hand and a clean cloth.
o
If
possible elevate the bleeding part above the level of the heart to slow the
flow of blood.
o
Apply
pressure to blood vessels just above (closer to the heart than) the broken skin
to slow the blood flow. It is important to remember to NOT absolutely cut off
circulation by pressing on the artery with too much force. This gives your
body's natural clotting mechanism time to take hold. Look at your body and
identify good pressure points where blood vessels are close to the skin
surface, do not confuse them for veins.
Cool the affected area with a face cloth dampened with cold
water once the area has stopped bleeding (see tips). The lowered temperature slows the
flow of blood to the area.
Wash the affected area. Use regular soap and cool water. Remove all dirt and
debris from on/around the wound. It may be necessary to scrub the wound bed
gently to remove all particles of debris. You may also flush the wound with
clean water to remove debris or irrigate with a saline solution if available.
If the wound begins to bleed again, apply direct pressure with a clean cloth or
gauze pad.
Apply a thin layer of an anti-infective ointment to the skin
around the cut (such as Amerigel or Neosporin). Carefully bring the edges of the
wound together and secure with a dressing.
Change the dressing at least once a day. Do so more often if the dressing
becomes wet or soiled. Wash the area gently with soap and water, apply the
anti-infective ointment and recover. Take care not to pull the wound apart.
6. 6
Leave
the wound open to air once a scab begins to form. Take care to keep it clean as
possible at all times. You may also want to apply a "liquid
bandage"/regular bandage (such as a Band-Aid) at this point for added
protection or to proceed to apply ointment to the affected area.
Do not use Neosporin
on puncture wounds!
Soak the affected area in hydrogen peroxide. This will help draw out any fine
particles deep in the wound and also acts as an anti-infective. Do this a
couple times a day for the first day or two. If it is not getting better or is
getting worse, take it to your doctor.
2. 2
Cover
with a clean dry dressing, sterile if possible. Change after each soaking. By day two
or three the wound should be "clean" and healing well. Apply a liquid
bandage for added protection.
Leave open to air. Bathe the area a couple times a day with hydrogen
peroxide. Spray with Bactine. If you notice the area becoming reddened and tender,
or if there is yellow or green drainage from the wound, coat with
anti-infective ointment and cover with a clean dry dressing.
3. 3
Apply
a liquid bandage for added protection.
These instructions
are for minor burns ONLY. (first degree and small second degree) Please see
Tips for a link to useful information about burns.
Halt the burning process. In the case of a chemical burn, you must neutralize the
burning chemical. Place the affected part under cool running water (warm water
for less harsh chemicals or when there is chemical exposure to the eyes) for
approximately 15 minutes or until thoroughly flushed. If you are not near
water, apply cool compresses to the area with gauze. Keep water on the area for
10-15 minutes, then remove for a couple minutes then reapply. Do not apply
ice, as it is cold enough to increase tissue damage rather than reduce it.
o
Applying
aloe vera directly to a burn prevents a blister from forming. If you have an
aloe vera plant handy, cut off a small piece from the plant, slice the piece to
expose the inner part of the plant, and gently apply it to the burn.
o
Honey has antibacterial and
anti-inflammatory properties that may prevent infection and promote healing.
One study conducted in 2006 found that small, non-serious burns healed faster
when treated with gauze and a dash of honey, on average, than those treated
with antibiotic creams and other dressings. A separate report published earlier
found similar results.
o
Mustard acts as both a pain reliever and
blister reducer.
o
Rubbing
a potato slice onto the burned area neutralizes the burn and
helps prevent scarring.
o
Egg
whites can take away
the pain and also prevent marks and scars.
o
Other
items to try include chamomile tea, corn starch, lavender oil, mint, and
oatmeal
Leave a burn open to air and keep area clean. Spray with Bactine. A blister will
form within 24 hours if you have a second degree burn. If a blister forms, try
to keep it intact. Do not attempt to break the blister! Applying
a liquid bandage to a blister can toughen the skin and decrease the chance of
it breaking.
o
If
the blister opens, you now have an open wound. Wash the area gently with soap
and water.
Bring the edges of the skin together (the empty blister is a
better protection for the underlying burned skin). Apply liquid bandage and cover with a
clean dry dressing. If redness, tenderness or drainage develops, apply
anti-infective ointment and cover the burn with clean gauze to protect it while
it heals. Change daily.
o
Contact
a physician if the burn gets worse, doesn't appear to ease, or develops severe
blisters or discoloration of any kind.
Drink lots of water until your burn heals completely. The extra moisture will help to
soothe and heal the burn. Also consider taking vitamin supplements that will
help your skin as it heals from the burn. Good ones to consider include vitamin
A, C, E, Echinacea, St. John's Wart and/or zinc.
·
Wash your hands thoroughly with ordinary hand soap and water
(preferably warm) before touching the wound. Wear clean medical gloves if you
have them when treating others. Then, after removing the gloves, wash your
hands again. Dispose of the gloves by sealing them in a bag (plastic zip-locks
work well) and discarding them where they can not be handled by others.
·
Clean the wound and change the dressing at least once a day, or
if it becomes soiled or wet.
·
Pack a portable wound care kit in a Ziploc bag: A small bottled
water, bactine or neosporin, a handful of gauze pads or clean cloths (wash
cloths), a few band aids, a roll of wide silk tape, a roll of gauze and my
favorite: Second Skin liquid barrier.
·
A good protective device for wound dressings on the hand is to
just wear a rubber glove. The glove will help keep the dressing clean and dry.
·
Tetanus is a concern, if you haven't gotten a tetanus shot, get
one.
·
To make an ice pack: fill a Ziploc sandwich bag about 1/2 full
of (preferably crushed) ice and seal. Wrap in a dish towel or pillow case. Ice
packs are used to cool burns, reduce swelling and bruising after an impact
injury, and to slow bleeding initially, in the case of an open wound. Remove
the cold pack every 10-15 minutes or if it becomes uncomfortable and allow the
skin to warm up. This protects you from freezing and further damaging the skin.
·
Signs and symptoms of infection include: Redness and tenderness
to the affected area, yellow or green opaque drainage, elevated body
temperature, cold sweats, chills.
·
Learn about First Aid before you need it. Be prepared.
Warnings
·
If in doubt, seek medical attention.
· If
infection develops that is not resolved quickly with anti-infective ointment,
seek medical attention.
· If
the wound is bleeding profusely, or blood is pulsating from the wound, do not
waste time trying to clean the wound. Control bleeding first, then seek prompt
medical attention.
· Do
NOT apply hydrogen peroxide, alcohol, iodine, betadine, or any other
"disinfectant" to an open wound unless specifically instructed to do
so by a physician. These chemicals are very irritating, can destroy newly
growing cells, and may increase, rather than reduce, the potential for
complications in healing. These chemicals have no place in a home or car first
aid kit.
· Keep
pressure on the wound until bleeding stops, but do not cut off circulation to
the area completely.
· If
you have a chemical burn, or if you feel the burn is deeper than just the first
layer of skin, seek medical attention.
· This
instruction is for minor wounds only.
· If
the wound bleeds through the applied bandages, do NOT remove the bandages to
apply new ones. Doing so would interrupt the clotting process and cause more
bleeding. In such a case, it is best to simply layer more bandages on top of
the bandages and call an ambulance.
EditThings You Need
·
Anti-infective ointment such as Neosporin
·
Liquid bandage such as Second Skin or Skin Prep
·
Gauze pads or clean cloths
·
Rolled gauze
·
Silk tape
·
Band aids
·
Clean water
·
Medical rubber or vinyl gloves
·
Also see natural care for burns
• staunch the bleeding from a cut by pressing hard on
it. Keep this up without
interruption for 10 minutes.
If the bleeding continues, repeat by applying more
dressing on top.
Press on this for another 10 minutes with your hand or use an
elasticated bandage.
• if you can’t stop the bleeding, telephone immediately for
medical help.
• if you have symptoms of physiological shock, telephone
immediately for medical
help.
• a cut that does not gape open and which has stopped
bleeding can usually be
cared for at home. Make sure it is clean and cover it with a
dressing.
• treat all burns or scalds without delay. Immerse the injured area in cold running
water for least 10 minutes.
• burns can usually be cared for at home if they are no larger
than the area you
can cover with your thumb.
• burns can usually be cared for at home if they just redden
the skin (no large
blisters, no numb areas; no charring; no bright red areas).
• do not burst or prick the blisters that form on burnt skin.
• if a wound is to your hand, foot, head, stomach or genital
area, always seek
advice from a GP surgery or hospital emergency department.
• seek medical advice if you begin to suffer dizziness or
feel faint (especially when
suddenly standing up).
• seek advice if a wound appears infected or isn’t healing
as you think it should.
• replace fluids lost from a cut or b
WHEN MOUNTAIN BIKING:
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Fingertip Bandage
The fingertip bandage has a narrow center with wide adhesive flaps. The narrow "waist" allows it to cover a curved surface without wrinkling. Some uses for this bandage are:
1. protecting a shallow laceration of the fingertip or thumb tip
2. covering a cut or abrasion between the fingers or toes
3. protecting a loose fingernail or toenail (partial nail avulsion)
4. covering a small chin or nose abrasion
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A laceration may be treatable at home if:
1. there is no protruding fat (see the section on injuries)
2. the laceration stops bleeding rapidly (within ten minutes)
3. the edges appear to match perfectly
4. the cut doesn't open with traction on nearby skin
5. the edges don't separate with use of the injured part
6. the area is not "tricky" or critical (such as face, genitals or knuckle)
7. there is no numbness, weakness, or difficulty moving the injured area
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Knuckle Bandage
The knuckle bandage has four adhesive flaps. The flaps allow the bandage to remain secure on a curved or moving area. Some uses for this bandage are:
1. protecting a shallow laceration on a knuckle
2. covering an abrasion on a "curve" like the heel or chin
3. covering an abrasion or cut on the back of the elbow
4. covering any area where the skin stretches or moves
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Large Plastic Bandage
The large plastic bandage is used to cover a wound of intermediate size. This usually will be a skin surface injury such an abrasion or superficial burn. To cover and protect, the injury area must be fairly flat.
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Sample uses for this bandage could include:
1. an open wound (such as an abrasion) on the thigh
2. a scrape on the shoulder
3. a small burn on the trunk or thigh
A bandage of this type does NOT provide adequate protection for a large laceration, because it doesn't provide any compression or traction to keep the cut closed.
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Plastic Bandage Strip
A plastic bandage can be used to cover a simple, small wound. The wound must NOT need padding or compression. A plastic bandage should only be used over a non-moving area -- for example, the space between the knuckles on the shaft of a finger is OK; between the fingers or over a knuckle is NOT.
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Sample uses of plastic strips include:
1. a small shallow puncture wound that is not bleeding
2. A partial thickness laceration on a finger (not over the knuckle)
3. a tiny abrasion on a non-moving area
Plastic strips are NOT appropriate for wounds where the skin stretches with motion -- for example on the back of the elbow or underside of the wrist. They're NOT to be used on lacerations that require intervention to close.
Cloth bandages are more flexible over moving parts. But they tend to fray and unroll from the wound. The adhesive on a cloth bandage is more likely to leave a residue. So for most cuts, a plastic bandage is a better choice. But where the cloth bandage works, it's wonderful.
Laceration Closure
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Butterfly Bandage
A butterfly bandage is used to pull the edges of a short laceration together. Typically, a butterfly is used for a small cut that tends to gape a bit. The edges of the cut must be sharp, not rough or irregular. (See the laceration information in the injuries section.)
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Because the butterfly dressing does NOT stretch, it can only be used where the skin will not stretch or shift while the wound heals. In general, steri-strip closure is preferred to butterfly bandages.
To place the butterfly, the laceration edges are pushed together. The strip is placed across the wound (long direction of the strip aiming 90 degrees opposite the long direction of the cut). One side is pressed firmly into place, with the narrow waist lying directly over the cut. Then the second "paddle" is pushed onto the skin. The butterfly is left in place while the cut heals. It's usually best to protect the butterfly by covering it with a gauze pad and a kling wrap.
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Wound Closure Tape
Steri-Strips (TM 3M) are wound closure tapes. They are ideal for partial thickness cuts. Steris are more flexible than a butterfly bandage, and can close longer lacerations.
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After cleaning the laceration, dry the surrounding skin. Apply benzoin tincture to the skin (don't get it in the cut). Cut the strips, then push the laceration edges together. Place strips across the wound (long direction of the strip aiming 90 degrees opposite the long direction of the cut). Protect with gauze (without antibiotic ointment) and a wrap.
The steris can be left in place while the heals. Steri-Strips may not provide good long-term protection in areas where the skin shifts or stretches (underside of the wrist, back of the elbow). The only disadvantage is: they're not as easy to find as butterfly bandages, and they're more expensive.
Dressing Pads
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Non-adherent Pad
Non-adherent pads are useful to cover open wounds such as burns and abrasions. The brand known best is Telfa. The pad keeps the dressing from sticking to the wound.
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After cleaning the wound, antibiotic ointment is applied. Be sure the patient isn't allergic to the antibiotic. The non-stick pad is placed next, then a gauze pad to cushion and protect. A kling wrap keeps the gauze in place.
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Gauze Pads
Gauze pads cushion and protect wounds. They also prevent dryness in an open wound. (The gauze pad shouldn't be placed directly on an open wound, because it will stick.) The gauze pads have a loose weave, so blood and fluids can ooze pass through to be absorbed.
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To construct a dressing, first place a non-stick pad. Put the gauze directly over top. Bind it down with a roller gauze (kling wrap). If you need compression (either to prevent swelling or bleeding, or to keep the bandage in place), add an elastic wrap or Coban wrap. Otherwise, apply just enough tape to keep the dressing in place.
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Padding Roll Gauze
Padding roll gauze is very useful to cushion large wounds. It's often called "Kerlix," which is a specific brand. It can be used in place of a kling wrap in the dressing, and for many wounds provides enough padding that gauze pads are not required. It absorbs ooze or blood, and prevents dryness in an open wound.
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The padding roll gauze can also be used for compression dressings, for example to compress a sprained ankle. Apply it under the elastic wrap.
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Sanitary Napkin
While lady bikers may carry a napkin or panty-liner for "emergencies" on the trail, there are other uses. The pad is sterile, absorbent, doesn't gum up and stick to the wound like toilet paper, and removes in one piece.
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The pad makes an excellent temporary dressing. It can also be used as padding over an injury. It's large enough to give a sterile covering for a big wound, open fractures, or exposed viscera.
Guys: The only drawback to taking your wife's "emergency supply" from the glove compartment is that -- admit it -- most of you would rather bleed to death or die of infection than be seen with it.
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Trauma Dressing
The multi-trauma dressing can be used as padding, or as coverage. Coming in various sizes, these dressings unfold to cover (for example) the entire chest or abdomen.
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The large size makes it useful for covering large areas of burn or abrasion while you travel to a medical facility. It can be used to cover exposed viscera. The dressing can be used to pad an injured arm or leg inside a splint.
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Eye Pads
Eye pads are padded dressings for the eye. Eye pads are used to keep the eye shut following minor eye injuries such as a corneal abrasion. Depending on the depth of the eye socket, you may have to fold a pad in half to get the right amount of pressure.
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The eye pad is taped in place. Run the bands of tape in an oblique direction: aim the top end for the middle of the front hairline and the bottom end for the angle of the jaw.
NOTE: You should NOT tape an eye pad over an eye that may have been punctured, or that has an impaled object. Instead, tape a paper drinking cup (with the open end facing the eye) over the eye.
Eye pads can also be used to provide local pressure over a wound. For example, to get control of bleeding in a puncture wound: place a couple of eye pads directly over it, secure it with a kling wrap, then use a compression wrap to apply pressure.
Securing a Dressing
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Roll Gauze
Roller gauze is used to secure dressings. This type of bandage is called a kling wrap. Pick a size appropriate to the wound, and to the body part you'll be bandaging. For example, a 1 inch roll is appropriate for fingers, while a 3 inch roll is about right for the upper arm.
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To construct a dressing, first place a non-stick pad. Put the gauze pad directly over top. Bind it down with your roller gauze. If you need compression (either to prevent swelling or bleeding, or to keep the bandage in place), add an elastic wrap or Coban wrap. Otherwise, apply just enough tape to keep the dressing in place.
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Padding Roll Gauze
Padding roll gauze is very useful to cushion large wounds. It's often called "Kerlix," which is a specific brand. It can be used in place of a kling wrap in the dressing. It absorbs ooze or blood, and prevents dryness in an open wound.
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The padding roll gauze can also be used for compression dressings, for example to compress a sprained ankle. Apply it under the elastic wrap.
To construct a dressing, first place antibiotic ointment, then a non-stick pad. Put a gauze pad directly over top. Bind it down with the padding roll gauze. If you need compression (either to prevent swelling or bleeding, or to keep the bandage in place), add an elastic wrap or Coban wrap. Otherwise, apply just enough tape to keep the dressing in place.
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Self-adherent Compression Bandage
Coban is a sample brand of self-adherent compression wrap. It sticks to itself, but does NOT stick to you. It can be used in many of the situations where you would use an elastic bandage (ace wrap). It's lighter and more conforming to your shape.
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Example uses for Coban wrap would be:
1. compression of a healing shin muscle strain during sports
2. support for a healing wrist sprain at work
3. placement over a kling wrap to compress an injury
Coban does not rip. Use your scissors to cut it to the right length. In general, the wrap should be tightest at the end that's furthest from the heart.
Watch for signs that the wrap is too tight -- such as swelling, numbness, discoloration, or pain "downstream" from the wrap. Coban contains latex, to which some people are allergic.
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Elastic bandage
Often called an "ace wrap," the elastic bandage is a roll of loose-weave cloth containing elastic strands. Wrapped around the extremity or trunk, it squeezes the underlying tissues.
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Its uses are:
1. compression of injuries such as a sprain or bruise
2. elastic immobilization or support of injured parts
3. securing the dressing on a large open wound
4. control of bleeding in wounds or fractures
5. symptom control in rib fracture
Select a size appropriate to the injured part: adult wrist = 2 inch, adult ankle = 4 inch, adult thigh or chest = 6 inch. In general, the wrap should be tightest at the end that's furthest away from your heart. Be careful that the wrap doesn't cut off circulation -- watch for swelling, discoloration, increasing pain, or numbness "downstream" from the wrap.
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Tape
Tape can be used to secure a dressing, but it's not the ideal choice. (A kling wrap secured with self-adhering wrap such as Coban is ideal. But tape may be useful when pressure is needed on a finger wound, or when you need a little extra security to keep a dressing from unraveling.
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Cloth tape is made to have excellent strength, yet still be "tearable." The tape can be used for:
1. securing a dressing
2. taping a splint
3. "sticky pickup" of glass fragments from the skin
4. taping a joint for stability
To tear the tape, use a sideways "shearing" force.
Immobilization
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Aluminum Splint
A bendable aluminum splint can be used to immobilize finger injuries. Some types of this splint have a foam strip glued to the metal for cushioning.
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Sample uses:
1. immobilizing a laceration over a finger joint
2. treating minor finger sprains.
3. treating finger tendon strain
The splint can be cut to length with your EMT snips. Bend it to the position desired; the finger is usually most comfortable in a "half-bent" position. The splint is secured with bands of tape.
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Triangular Bandage
The triangular bandage's primary use is as a sling. But it can be surprisingly handy. The triangular bandage can also be used as a tie for a splint on the arm or leg. It can be used as a wrap to secure a dressing. In a pinch, it can even replace a broken helmet strap.
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Unfold the cloth. Bring the long ends together around the neck, with the pointy end at the elbow. Secure it with a knot or pen. Keep the elbow from sliding out by typing a knot, pinning the flap, or tucking the extra cloth in.
