Friday, July 31, 2009

FIRST AID (Spinal Cord Injury )

Overview
• Spinal cord injury is otherwise called 'myelopathy'
• It results in an injury to the nerve fibers in the cord
• Can cause loss of physical sensation and mobility
• Spinal cord remains intact in most of the injuries
• Complete injury causes no movement/sensation below injury
• Incomplete injury-retains some movement/sensation below injury
• Physical therapy, ventilators, wheel chairs often required
Causes
• Automobile accidents
• Diving accidents
• Falls
• Shot by a gun
• Conditions like
a. Polio
b. Tumor
c. Spina Bifida
d. Friedreich's Ataxia
Symptoms
• Loss of sensation
• Loss of motor functions
• Loss of bowel/bladder functions
• Sexual function can get affected
• Loss of involuntary functions, like breathing
• Inability to control rate of heart beat
• Inability to sweat
• Chronic pain
Treatment
Seek medical help or call for an ambulance as soon as possible. Meanwhile-
• Move the person, if surrounding is not safe
• Immobilize the head, neck and body on both sides
• Movements may dislocate vertebra and cause further injury
• If there is no sign of breathing, perform CPR
• Do not tilt head backward during CPR
Prevention
• Always wear a seat belt while driving
• Use special seat belts for children and babies
• Do not drink and drive
• Do not dive into a shallow pool area

FIRST AID (Snake Bites )

Overview
• Thousands suffer from snake bites, globally, every year
• People who live near wilderness/trekkers - more prone
• Even bite from a harmless snake can cause allergic reaction
Causes
Some common venomous snakes include -
• Viper
• Cobra
• Rattle snake
• Water moccasin
• Coral snake
• Copper head
Symptoms
• Fang marks
• Swelling/severe pain at the site
• Bloody discharge from wound
• Burning
• Diarrhea
• Excessive sweating
• Blurred vision
• Numbness/tingling sensation
• Increased thirst
• Vomiting
• Fever
• Loss of muscle co-ordinations
• Convulsions
• Rapid pulse
• Weakness/Dizziness/Fainting
Treatment
a. Seek Medical help as soon as possible. Meanwhile -
• Wash wound with soap/water
• Immobilize the affected area
• Keep area slightly elevated
• Apply cool compress/wet cloth to affected part
• Apply a firm bandage 2-4 inches above bite to
i. Prevent venom from spreading
ii.Take care of any bleeding
b. Monitor for pulse, respiration and blood pressure
Prevention
• Do not attempt to kill a snake.
• If you spot a snake, leave it alone
• While hiking or in the woods, stay out of tall grass
• Do not put your hand into pits/crevices during treks
• Exercise caution while climbing rocks

FIRST AID (Tooth Ache )

Overview/Causes
• Tooth ache is primarily caused by tooth decay
• Bacteria flourishes on sugar/starch in food particles inside mouth
• A sticky plaque is then formed on teeth surface
• The bacteria in the plaque produces acid
• This acid erodes the enamel or hard covering of the teeth
• This creates a cavity
• The first sign of tooth decay is tooth ache
• This occurs on eating something very cold/very hot/sweet
• Tooth ache can also be caused by injury/trauma
• Tooth ache can occur in children and adults
Symptoms
Pain in the tooth radiates to jaw, cheek, ear
• Pain while chewing
• Increased sensitivity to hot/cold things
• Swelling in the jaw
• Discharge/Bleeding from tooth or gums
Treatment
• Use a floss to remove any particle lodged between teeth
• Learn flossing from a dentist
• Take a pain relieving tablet
• Apply benzocaine containing antiseptic
• Applying clove oil also might help
• Do not place aspirin directly against the gums
• This might lead to burning of gum tissue
Consult a Doctor
If
• Tooth ache persists
• Fever occurs with the ache
• Difficulty in breathing occurs
• Difficulty in swallowing occurs
Prevention
• Brush teeth after every meal
• Floss regularly
• Visit your dentist twice a year
• Wear a mouth gear while playing
• Avoid smoking as it worsens dental conditions
• Eat a balanced meal with reduced starch/sugar content

FIRST AID (Foreign Object In The Nose )

Overview
• Any outside object inserted into nose
• Usually children are the affected ones
• During play, they insert small objects into nostrils
Causes
• Food particles
• Erasers
• Dried seeds
• Objects, like crayons
• Beads
• Buttons
Symptoms
• Irritation
• Infection
• Foul smelling / bloody discharge from nose
• Breathing difficulty
Treatment
• The person must be urged to breathe through mouth
• The person should avoid breathing with force
• Close the unaffected nostril
• Blow out gently through the affected nostril
• Get medical aid if this method fails
Steps to Avoid
• Do not probe an object which is not seen
• Do not probe an object that is not easy to grasp
• Do not blow nose too hard
• Do not use sharp instruments to remove the object
Consult a doctor
• When the object cannot be removed
• When the victim suffers from infection
Prognosis
• No problem expected once the object is removed
Prevention
• Children must be trained not to put objects in body openings
• Small objects must be kept out of reach of children

FIRST AID (Foreign Object In The Skin )

Overview
• When object is lodged in the skin layers
• It may be embedded superficially or deeply
Causes
• Caused by glass
• Wood splinters
• Fiber glass
Symptoms
• Irritation
• Pain
• Abscess
Treatment
• Wash hands well
• Clean the affected area using soap, water
• If object is visible above skin, squeeze the area around
• When object pops out, remove using sterile tweezer
• If embedded under skin, use a sterile needle
• Sterilize needle by flaming/wiping with alcohol
• Use needle to break skin over affected area
• Lift tip of the object
• Use a small tweezer to pull it out
• Gently squeeze the area and let bleed
• Clean the area with soap, water. Pat dry
• Apply an antibiotic
Steps to Avoid
• Do not wet if the object is of wood
• Wet wooden objects swell- becomes difficult to remove
Consult a doctor
• If the object is difficult to remove
• If the object is close to a sensitive body part, like the eye
• In case of infection

FIRST AID (Foreign Object When Swallowed )

Overview
• Most objects swallowed will be eliminated naturally
• Sharp objects/objects like battery are dangerous
• Sharp objects should be removed
• Can happen to all ages
• Common in children of 1-3 years
Causes
• Certain food like popcorn
• Coins
• Small toys
• Small objects like buttons, beads
Symptoms
• Coughing
• Difficulty in breathing
• Wheezing
Treatment
• If breathing is difficult, do Heimlich maneuver
• Seek medical help as quickly as possible

On someone else
• Stand behind the person
• Wrap your arms around victim's waist
• Tilt the person a little forward
• Make a fist with one hand
• Place it just above the navel
• Hold the fist with the other hand
• Give a hard upward thrust into the abdomen
• Repeat if required

On Oneself
• Make fist with one hand
• Place fist above navel
• Hold it with other hand
• Bend over a hard surface like a chair
• Give hard upward thrust
• Repeat if required
Prevention
• Do not give potentially dangerous food to children
• Give small pieces of food to children
• Avoid laughing / talking when eating

FIRST AID (Fracture )

What is fracture?
• A broken or cracked bone
• Occurs when pressure is applied to bone
• Occurs with / without displacement of bone fragments
Types
• Open fracture: Skin breaks causing open wound
• Closed fracture: Skin not broken
• Complicated fractures: Damage of adjacent organs
• Stress fracture: Hairline crack due to repeated stress
• Greenstick fracture: In children's flexible bones
Symptoms
• Severe pain
• Difficulty in movement
• Swelling/ bruising / bleeding
• Deformity / abnormal twist of limb
• Tenderness on applying pressure
First-aid
• Depends on type & location of fracture
For open fractures
• Control bleeding before treatment
• Rinse and dress the wound
For open / closed fractures
• Check the breathing
• Calm the person
• Examine for other injuries
• Immobilize the broken wound
• Apply ice to reduce pain / swelling
• Consult a doctor
DO NOT
• Massage the affected area
• Straighten the broken bone
• Move without support to broken bone
• Move joints above / below the fracture
• Give oral liquids / food
Prevention
• Wear protective pads / helmets when driving
• Teach children / practice, safe habits

FIRST AID (FAINTING )

About Fainting
• Fainting occurs due to decreased blood supply to brain
• A fainting spell is usually very brief
• It may or may not have medical significance
Common Causes
• Anxiety
• Emotional upset
• Stress
• Severe pain
• Skipping meals
• Standing up too fast
• Standing for a long time in a crowd
• Some medications
• Diabetes
• Blood Pressure
Symptoms

Before fainting, a person may experience the following:
• Nausea
• Giddiness
• Excessive sweating
• Dim vision
• Rapid heart beat or palpitations
Treatment
• Fainting is a medical emergency, till proven otherwise
• When a person feels faint-
Make them sit down or lie down
• If sitting, position head between knees
• When a person faints, position him on his back
• Check to see if airways are clear
• Restore blood flow by
Loosening clothing/belts/collars
• Elevate feet above head level
• Patient should become normal within a minute
• If not, seek medical help
• Check if breathing/pulse is normal
• If not, do Cardio-pulmonary resuscitation (CPR)
Prevention
• When symptoms appear, lie down
• Try do avoid stress and anxiety
• Carefully evaluate your medications
• Take care of underlying medical conditions

FIRST AID (Dislocation )

About Dislocation
• An injury which forces bones out of their sockets
• Dislocation is a common sports injury
• It temporarily deforms or immobilizes the joint
Causes
• Usually caused by a trauma like a fall/blow
• Rheumatoid arthritis also causes dislocation
Symptoms
• Pain
• Tenderness
• Difficulty to move injured part
• Swelling
• Discoloration
Treatment
• Call medical help as soon as possible
• Do not move the joint or try to place it back
• Place ice to control swelling
• If skin is cut, clean gently and bandage with sterile gauze
• Sling or splint the injury in its original position
• If injury is serious, check for breathing
• If not breathing, provide Cardio pulmonary resuscitation (CPR)
Elevate the feet up to 12 inches
• Cover the patient with a blanket
Prevention
• Wear protective gear while sporting
• Make home environment safe
• Teach safe habits to children
• Do not stand on chairs or other unstable objects
• Exercise care while using bath oils
• Make use of hand rails while using the stairs

FIRST AID (Diabetes )

What is Diabetes?
• Chronic health condition
• Insufficient insulin produced /used
• Affects sugar breakdown
Introduction
• Food eaten converted to glucose
• Glucose produces energy
• Insulin breaks down glucose
• Diabetics do not sufficiently produce or use insulin
• Causes blood sugar build-up in blood
Types

Type I diabetes
• Mostly occurs in children/young adult
• Insulin production affected
Type II diabetes
• Mostly occur in adults
• Body is partially/ fully insulin resistant
• Blood sugar level increases
Gestational diabetes
• Occurs in pregnant women
• Causes problems in mother and
baby
Symptoms
• Increased thirst
• Excessive urination
• Weight loss
• Weakness
• Vision changes
• Dry skin / dehydration
• Numbness in hands/ feet
Diagnosis
• Fasting blood glucose level> 126 mg/dL
• Random Blood Glucose> 200 mg/dL
Complications of diabetes
• Diabetic Retinopathy (eye)
• Kidney Disease
• Heart Disease and Stroke
• Nerve Disease
• Impotence (sexual disorder)
Treatment
Type I diabetes
• Daily Insulin injections
• Insulin cannot be taken as a pill
Type II diabetes
• Healthy diet and exercise brings down glucose level.
• Some people need diabetic medicine or insulin
Medications lower blood glucose level
• Sulfonylurea drugs & Meglitinedes: Produces insulin in the pancreas
• Biguanides: decreases glucose in liver
• ยต- glucosidase inhibitors: Slows the absorption of starch
• Consult a diabetologist or general physician

FIRST AID (Chest pain )

Overview
• Feeling of pain /discomfort between neck and abdomen
• Chest pain raises fear of heart attack
• Any tissue or organ in chest can cause pain
• 'Angina' is heart- related chest pain

Causes
• Some mild, others life threatening
• Problems related to the heart
• Asthma
• Pneumonia
• Inflammation in the lung
• Inflammation / strain of rib muscle
• Anxiety
• Indigestion / ulcers in stomach
• Gall bladder stones
• Shingles
• Stress

Symptoms
• Pain or pressure in chest area
• May be accompanied by
a, Heartburn,
b, Vomiting,
c, Dizziness
d, Shortness of breath
e, Fever

Treatment
• If you have asthma or angina take your regular medications
• Medicines like acetaminophen and ibuprofen may help
• Consult a doctor if
a, Pain /fever /cough persists
b, Radiating pain occurs
c, Angina occurs at rest
d, The cough produces yellow -green phlegm
e, Pressure / tightness occurs
f, Nausea
g, Dizziness
h, Shortness of breath
i, Sweating
• Hospitalization may be essential
• Tests like ECG, may have to be taken

Prevention
• Maintain normal weight
• Exercise regularly for 30 - 40 minutes
• Check and control BP, diabetes, cholesterol
• Avoid smoking
• Control stress
• Eat low fat balanced diet
• Get health check ups done regularly

FIRST AID (Chemical Splash in the Eye )

Overview
When a toxic chemical is splashed into the eye(s), it could cause serious complications that may lead to blindness.

Causes
• Working with chemicals in factories
• Handling car battery
• Working in research laboratories
• Handling household chemicals
Symptoms
• Irritation in eye
• Eye Burns
• Watering of the eye
Treatment
• Lay the person on the floor
• Keep eye lids open forcibly
• Use clean cold water to wash eyes gently
• Keep washing steadily for at least 20 minutes
• Rinse/wash hands thoroughly to remove chemical
• If wearing contact lens remove them
• Do not rub eyes
• Do not use eye drops until told
• Wear sunglasses to minimize irritation
• After these basic steps seek medical help
• Remember the name of chemical to tell doctor
Prevention
• If working with chemicals, wear protective face-mask
• Wear eye goggles whenever required
• Do not be careless with chemicals
• Store household chemicals safely
• Keep chemicals out of reach of children

FIRST AID (Black Eye )

What is Black eye?
• A bruise in the tissues around the eye/eyes
• Results from injury to face/head
• Causes swelling and dark coloration of eye
• Hence, "black eye"
• Usually a minor problem
• Sometimes it indicates a serious injury
• One or both eye affected
Causes
• Blow to eye / nose
• Facial surgical procedures
• Allergies
• Bites
Symptoms
• Discoloration of eye
• Swelling
• Blow to nose causes swelling of eye
• Head injuries may blacken/swell eyes
• Pain
• Blurry vision due to swelling
• Headache
Symptoms of severity
• Persistent headache
• Double vision
• Inability to move eye/eyes
• Blood on eye surface
• Blood/fluid issue from nose, ears
• Loss of consciousness
• Loss of sight
Treatment
• Black eyes generally heals within a few days
• Consult with specialist for serious injuries
Home remedy
• Apply ice for 20 min/hour, first two days
• If not better, apply warm compress once in two hours
• Do not use ice directly
• Wrap ice in cloth or use commercial pack
• Continue cold compress till severity eases
• Take acetaminophen, for pain relief
• Avoid aspirins / non-steroidal medications
• These medications may cause bleeding
• Stay away from strenuous activity
• See a medical specialist as soon as possible
Treatment for complications
• For head injuries-Neurosurgeon
• For nose injuries-ENT specialist
• For eye injuries-Ophthalmologist
• For face
• Injuries/disfigurement-Plastic surgeon
• Carry out follow-up as advised by doctor
Prevention
• Protect your eyes always
• Ensure safety at home by removing unwanted objects
• Avoid fist fights

FIRST AID (Bleeding Gums )

Overview
• Progressive disease affecting oral cavity
• Characterized by chronic bleeding of gums
• May lead to tooth loss
Causes
• Poor oral hygiene
• Inadequate plaque removal
• Oral trauma, like toothbrush abrasion
• Inflammation caused by infection
• Vitamin C / K deficiency
• Hot food
• Chemical irritants
• Leukemia
• Pregnancy
Treatment
• Apply pressure using ice-pack
• Mouth rinse: Pinch of salt in lukewarm water
• Rinse twice a day to reduce swelling
• Consult a dentist if bleeding continues
• Avoid aspirin intake
• Massage gums regularly
• Reline poorly fitted dentures
• Take vitamin supplements if necessary
Prevention
• Avoid Tobacco
• Avoid snacking between meals
• Reduce Carbohydrate- rich food
• Remove plaque every 6 months
• Brush teeth using soft-bristled brush
• Floss teeth regularly

FIRST AID (Back pain )

What is Back Pain?
• Short-term, acute pain in the back
• Indicates that body is under stress
Causes

Problems in:
• Bones and ligaments of spine
• Muscles and nerves of the Back
Back pain triggered by
• Poor posture
• Inappropriate footwear
• Incorrect walking habits
• Strained muscles
• Prolonged sitting
• Sleeping on soft mattresses
• Kidney, bladder, or prostate disorders
• Pregnancy
• Constipation
• Stress
First aid for back pain
• Rest in a comfortable position.
• Apply ice pack to affected area
• Painkillers or relaxants may be used
• Avoid strenuous exercise
• Avoid pillows
• Avoid sleeping on soft mattress
Treatment
• Anti-inflammatory drugs
• Massage with hot/ cold packs
• Traction
• Transcutaneous Electrical Nerve Stimulator
(TENS)
• Regular simple exercises
• Consult an Orthopedician if:
a. Pain persists
b. Difficulty in passing urine
c. Numbness or pain in legs or toes
Prevention
• Maintain good posture
• Do not smoke
• Avoid overstretching body
• Reduce stress/ strain
• Take breaks during work
• Sit straight with lower back support
• Use comfortable low-heeled shoes
• Do stretching exercises

FIRST AID (Asthma )

Overview
• It is a chronic lung disease
• It creates narrowing of air passages of the lung
• Produces difficulty in breathing.
Symptoms
• Wheezing
• Cough and cold
• Tightness in the chest
• Sticky mucus
• Disturbed sleep
• Breathlessness
Causes
• Hereditary factors
• Environmental factors like dust, mite, pollen
• Occupational exposure to irritants
• Dietary Changes
• Lack of exercise
Asthma Triggering Factors
• Colds and viruses
• Irritants like Cigarette smoke, scent, pollution
• Cold air or change in weather
• Physical exertion
• Allergens like dust, mite, pollen, furs
• Some medications
• Infections
• Stress
Myths about asthma
• It is contagious
• It cannot be controlled
• Asthma medicines are addictive
Management of Asthma
• Asthma cannot be cured, but it can be controlled
• Keep the house clean
• Use hardwood floors or tile
• Avoid carpets in house
• Avoid pets with fur or feathers
• Use clean bed sheets & pillow covers
• Use bed made of synthetic materials
• Use air conditioner
• Maintain low humidity at home
Treatment
• Anti-inflammatory drugs include:
a. Steroid Inhalers
b. Sodium Chromoglycate
Inhalers / Capsules
• Treatment –Bronchodilators
• Common bronchodilators include:
a. Salbutamol Inhalers
b. Terbutaline Tabs
• Consult your Pulmonologist
Famous sports person with asthma
• Ian Botham (Cricketer)
• Jackie Joyner Kersee (Athlete)
• Mark Spitz (Swimmer)

FIRST AID (Cardio-pulmonary Resuscitation (CPR) )

About Cardiac Arrest
• Often caused by abnormal heart rhythm
• This aberrant rhythm is ventricular fibrillation (VF)
• During VF heart stops pumping blood
• Patient may stop breathing
• No pulse may be detected
• A shock to the heart, called defibrillation, required
• Defibrillation stops VF, restores heart function
What is CPR?
• Emergency life-saving measure
• Combination of rescue breathing & chest compressions
• Done on unconscious/ non-breathing patient
• Done on persons suffering cardiac arrest
• Also for near-drowning/ asphyxiation/ trauma cases
• CPR conducts defibrillation
• Supports heart pumping for short duration
• Allows oxygen to reach brain
• Buys time till help arrives
• More effective when done as early as possible
THE VITAL STEPS
Clear the airway
• Assess if the person is conscious / breathing
• Lay the person on his back on a hard surface
• Using a head tilt -chin lift open his airway
• Check for breathing sound
• If not breathing, start mouth-to-mouth breathing
Mouth- to-mouth breathing
• Pinch the person's nostril shut
• Seal his mouth with your own
• Give the first breath, lasting one second
• Watch if chest rises
• If it rises, give second rescue breath
• If it does not rise, give a head tilt- chin lift
• Now give second rescue breath
Restore circulation through compression
• Place heel of your palm on patient's chest
• Place your other hand above first
Keep elbows straight
• Push down using upper body weight (compress)
• Push hard and fast
• After 30 compressions, clear airway
• Give two rescue breaths
• This is one cycle
• Give 100 compressions /minute
• Continue CPR till medical help arrives
CPR for children (under 8 yrs/ infant)
• Procedure almost same as for adult
• Following details should be incorporated
• 20 breaths/min should be delivered
• 100 compressions/minute should be given
• Chest compressions - given with one hand
Prognosis
• If done well, CPR saves life
• Normalcy is restored in rescued person
• CPR can also be ineffective, causing death
• In some cases, causes injuries / damages
Caution
• Ribs/heart/lungs/ liver may be injured
• After CPR, medical attention should be given
CPR training
• CPR - practical skill acquired through training
• Professional training/ regular practice mandatory
• CPR not confined to medical professionals
• Community organizations, like Red Cross, conduct training

FIRST AID (Electric shock )

Overview
• Injuries caused when electric current passes through body
• Source may be natural or man-made
What happens during electric shock?
• Makes you fall down
• Muscle contraction
• Seizures
• Dehydration
• Burns
• Fractures
• Clotting of blood
• Tissue death (narcosis)
• Respiratory/Heart/Kidney failure
Steps to follow
• Do not attempt to move the victim from current source
• First step is to switch off the current source
• Otherwise, move the source using a wooden stick
• Attend to the victim
• Check for breathing
• No breathing, do Cardio pulmonary resuscitation (CPR)
• Call emergency medical aid
• If breathing, do a physical examination
• Treat for minor burns
• Re-establish vital functions
• Excessive burns may require hospitalization/ surgery
• Supportive care must be provided
Prevention
• Proper design, installation, maintenance of electric devices
• Educating the public regarding electrical devices
• Keep electrical gadgets out of children’s reach
• Learn to respect electricity and electrical devices

Heart attack - emergency first aid

Reviewed by Dr Neal Uren, consultant cardiologist and Dr Reginald Odbert, GP
Important: this is a brief guide to the emergency help that can be given in the event of a heart attack or cardiac arrest before the arrival of emergency services. It is not intended as a replacement for a first aid or resuscitation course.
What should you do if someone has a heart attack?
If someone has a cardiac arrest or heart attack, there are only a few minutes to act before it is too late. It is vital to know what to do beforehand.
To perform CPR (cardiopulmonary resuscitation) and artificial respiration (mouth to mouth resuscitation) effectively, training and frequent practice on resuscitation dummies are essential.
First aid courses are offered all over the country at night schools or by voluntary organisations such as St John Ambulance or The Red Cross.
How can you tell if someone is having a heart attack?
If the person is unconscious:
• are they breathing? Look at the patient's chest to see if it is rising and falling.
• do they have a pulse? Place two fingers on one or other side of the person's voice box in their throat to feel if they have a carotid pulse.
If the patient has a pulse but is not breathing:
• could it be because of suffocation? Feel inside the mouth with a finger to see if there is anything blocking it or the windpipe and remove any food or other objects. Provided that dentures are not broken, it is better not to remove them.
• call for help immediately, stating that the casualty is not breathing, and provide resuscitation (see below) until the patient begins to breathe or the ambulance arrives.
If there is no breathing or pulse, the patient has had a cardiac arrest.
What help is needed?
• If possible, raise the legs up 12 to 18 inches to allow more blood to flow towards the heart
• Immediately place the palm of your hand flat on the patient's chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again.
If these actions do not restore a pulse or if the subject doesn't begin to breathe again:
• call for help, stating that the casualty is having a cardiac arrest but stay with the patient.
• find out if any one else present knows CPR.
• provide artificial respiration immediately (see below).
• begin CPR immediately (see below).
How to give artificial respiration
• Tilt the head back and lift up the chin.
• Pinch the nostrils shut with two fingers to prevent leakage of air.
• Take a deep breath and seal your own mouth over the person's mouth.
• Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest.
• Do this twice.
• Check to see if the chest rises as you breathe into the patient.
• If it does, enough air is being blown in.
• If there is resistance, try to hold the head back further and lift the chin again.
• Repeat this procedure until help arrives or the person starts breathing again.
How do I perform CPR (cardiopulmonary resuscitation)?
See if there is breathing. If not, start artificial respiration as described above. Checking for a pulse in the neck (carotid artery) may waste valuable time if the rescuer is inexperienced in this check. The procedure is:
• place your fingers in the groove between the windpipe and the muscles of the side of the neck. Press backwards here to check for a pulse.
If there is no pulse, or if you are unsure, then proceed without delay thus:
• look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
• now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
• keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
• press down firmly and quickly to achieve a downwards movement of 4 to 5cm, then relax and repeat the compression.
• do this 15 times, then give artificial respiration twice, and continue this 15:2 procedure until help arrives.
• aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four ...' etc.
Artificial respiration and CPR should both be performed at the same time
• If possible, get someone else to help - one person to perform artificial respiration and the other to perform CPR. (This is not easily done without prior practice and it is well worth attending sessions on CPR training to become familiar with the technique.)
• The ratio of chest compressions to breaths is 15:2 for both one-person and two-person CPR.
• Continue until the ambulance arrives or the patient gets a pulse and starts to breathe again.
• If the pulse returns and breathing begins but the person remains unconscious, roll them gently onto their side into the recovery position. This way mucus or vomit can get out of the mouth and will not obstruct the patient's breathing. It also prevents the tongue from falling back and blocking the air passage.
Make sure the patient continues breathing and has a pulse until the ambulance arrives
• If you succeed in resuscitating the person who has been taken ill, he or she may be confused and alarmed by all the commotion. Keep the patient warm and calm by quietly, but clearly, telling them what has happened.
Again, it needs to be emphasised that the only way to provide proper first aid and resuscitation is through learning the technique, then regular practice and guidance.
Based on a text by Dr Henrik Omark Petersen

FIRST AID (Shock and fainting)

Shock and fainting occur when only a small amount of blood circulates to the brain. This means that the brain is not receiving enough oxygen, which leads to a feeling of faintness, disorientation and dizziness.
Shock may also occur:
• after an accident involving loss of blood
• after a serious infection with loss of fluids
• after a serious burn
• after other accidents that cause loss of fluids or blood.
When the flow of blood in the body is too slow, the blood pressure drops and too little oxygen is circulated through the body. When this occurs a person will:
• go pale
• turn sweaty, clammy and cold
• become dizzy
• have a weak, fast pulse
• have low blood pressure
• have slow, weak breathing
• lose consciousness
• become anxious or restless.
What to do if someone is in shock or fainting
1. The person must lie on their back - preferably with their feet raised - to ensure enough blood gets to the brain.
2. Make sure the person is warm, comfortable and covered by a blanket if possible.
3. Do not give them anything to drink because they could run a risk of choking.
4. If the person vomits or bleeds from the mouth, he or she must be placed on their side to prevent choking.
5. Call for an ambulance. A person in shock must always be treated by a doctor.
References
Resuscitation council (UK) guidelines 2000. http://www.resus.org.uk/pages/guide.htm
References
First-aid kit
Reviewed by Christine Clark, pharmacist and Dr John Pillinger, GP
First-aid kit basics
A first-aid kit contains emergency supplies and medication for unexpected minor illnesses or accidents.
While it is vital for people who suffer from a chronic disease or condition to take their medication with them at all times, it is also a good idea for everyone to keep a first-aid kit in the home or car, or take one with them on holiday in case of emergencies.
If going abroad, talk to your doctor before leaving about arrangements for vaccinations or special medication such as malaria tablets.
Although it is possible to buy additional items for your first aid kit when you are abroad, it is a good safeguard to purchase extra supplies and medication before your departure. Emergency situations occur unexpectedly and you may find yourself unable to obtain essential items just when you need them most.
Remember that medicines suitable for adults are not always suitable for children as well. Always read the label to check who can take the medicines in your first-aid kit, and at what dose.
Motion sickness
Medication to prevent motion sickness caused by car, air or sea travel can be bought over the counter without prescription. If necessary, this should be taken before starting a journey.
Diarrhoea, irregular bowel movements or indigestion
It is a good idea to be prepared for diarrhoea. Medication to treat it is available both on prescription or over the counter at your local pharmacy.
If diarrhoea or vomiting occur despite these precautions you will need to make sure the patient gets enough liquid. This is especially important where children are concerned.
Cola drinks are particularly helpful since they replace essential salt and sugar as well as provide a source of liquid, but a first-aid kit should also contain a rehydration medicine (a powder or large tablet that is dissolved in clean water, for example Dioralyte) to prevent dehydration.
Many people get constipation when travelling. A mild laxative, available from a pharmacy, usually relieves most symptoms.
For people who suffer from indigestion or heartburn when eating spicy food, it is a good idea to keep a supply of antacid preparation in the first-aid kit.
Pain relievers
Aspirin (eg Aspro clear), paracetamol (eg Panadol) or ibuprofen (eg Nurofen) can be bought over the counter. They come in different forms including soluble tablets, ordinary tablets or suppositories, and can relieve headache, muscle pain, toothache and period pain. Aspirin should not be given to children under 16 years of age, unless on the advice of a doctor.
Fever
Fever is most commonly caused by viruses that cannot be treated with antibiotics. Even though antibiotics can be bought in some countries without a prescription, they should be avoided. If antibiotics are necessary, a GP should be consulted. A doctor will be able to prescribe the appropriate antibiotics or other medication.
Sunburn
A sunblock to be applied prior to exposure to the sun should always be included in a first-aid kit, along with cream and lotion for use after sunbathing. The pharmacist should be consulted as to the appropriate screening (SPF-sun protection factor) level.
Insect bites
Antihistamines and soothing lotions such as calamine are effective at controlling the itching of insect bites or stings.
Cuts and grazes
The following items are all useful for treating minor cuts and grazes:
• sticking plasters
• cotton wool
• safety pins
• a gauze bandage and supportive bandages
• antiseptic lotion or saline to clean wounds.
Do I need to take everything wherever I go?
There is no need to take everything with you. Indeed, a longer trip might require more supplies than a shorter one. Buy products in small sizes that fit easily into your luggage. Remember that all drugs have a 'use by' date and should be thrown away after they have expired.
Based on a text by Dr Per Grinsted, GP and Dr Erik Fangel Poulsen, specialist

FIRST AID (Choking)

Choking happens when the passage through the windpipe is blocked. This usually occurs when food that has not been thoroughly chewed gets stuck.
If someone looks like they are choking, ask them if they are able to talk.
A person who is genuinely choking can usually only communicate with hand movements, and may place their hand against their throat. In such a case they will definitely need help, so summon assistance for them.
Provided the person is conscious and breathing, you should not interfere. However, be prepared to do so if the obstruction appears to become complete or markedly worse.
The best way to relieve choking is by using the Heimlich manoeuvre.
The Heimlich manoeuvre
1. Stand behind the person who is choking.
2. Place your arms around their waist and bend them well forward.
3. Clench your fist and place it right above the person's navel (belly button).
4. Place your other hand on top, then thrust both hands backwards into the stomach with a hard, upward movement.
5. Repeat this until the object stuck in the throat is expelled through their mouth.
If you need to carry out this manoeuvre on yourself, place a clenched hand above your navel (belly button) and your other hand on top. Then thrust your fist hard into your stomach.
Repeat this until the object stuck in the throat is expelled through the mouth.

FIRST AID (Bleeding)

With all types of bleeding, it's important to stop the flow of blood as quickly as possible.
Small cuts
Small cuts in the veins stop bleeding and clot within a few minutes. The area should then be washed, and a plaster placed gently on top.
Deeper cuts
Deeper cuts in the veins produce dark blood that seeps out slowly and steadily. It can be stopped by gentle pressure on the wound with a sterile or clean cloth, followed by the application of a clean or sterile bandage.
Often, these wounds need sewing or glueing, and therefore medical treatment will be necessary after first aid.
Arterial bleeding
WARNING!
Arterial bleeding must always be treated by a doctor.
Bleeding from an artery can cause death within a few minutes, so urgent first aid is essential. This type of bleeding pulsates and squirts blood as the pulse beats. The blood is often a light red colour.
To stop bleeding from an artery:
• apply hard pressure on the wound and keep this up until the patient receives medical treatment.
• press with a sterile cloth or just use your hand if nothing else is available.
• put a bandage on the wound if possible. If the blood soaks through the bandages, press harder until the bleeding stops.
• do not remove the soaked bandages, but place another on top if necessary.
• do not attempt to clean the wound.
The person must be made to lie down, preferably with their head lower than the rest of their body. This will ensure that enough oxygen gets to the brain.
If possible, position the wounded area higher than the rest of their body so that the pressure, and therefore the bleeding, will be reduced.
Nosebleeds
Nosebleeds occur when one of the small blood vessels in the mucous membranes of the nose bursts.
Do not bend the head backwards or lie down, because this increases blood pressure in the head and so increases the bleeding. Blood may also run into the stomach.
To limit the bleeding:
• pinch the nostrils shut with the index and middle finger for 10 minutes. This way, the vein is pressed together, which is often enough to stem the flow.
• while the nostrils are shut, the person must breathe through their mouth.
• if the bleeding continues, it is important to contact a doctor.
If the person frequently suffers sudden, intense nosebleeds, they should also consult a doctor.

FIRST AID (Breathing difficulties)

If someone stops breathing, see if the person replies if talked to or touched on the shoulder. If not, call an ambulance and then begin first aid.
1. Place the person on his or her back on the floor.
2. Tilt the head so that the chin is pointing upwards. Do this by placing the fingertips under the jawbone, then lift gently while pressing down softly on the person's forehead. This is done to make sure the tongue is not blocking the throat.
3. Keep holding the head in this way while checking for breathing: see if the chest is rising and falling, or place your ear next to their mouth to listen for breathing.
4. If there is breathing, hold the head as described above until help arrives. If not, start artificial respiration.
How to give artificial respiration
• Tilt the head back and lift up the chin.
• Pinch the nostrils shut with two fingers to prevent leakage of air.
• Take a deep breath and seal your own mouth over the person's mouth.
• Breathe slowly into the person's mouth - it should take about two seconds to adequately inflate the chest.
• Do this twice.
• Check to see if the chest rises as you breathe into the patient's mouth.
• If it does, enough air is being blown in.
• If there is resistance, try to hold the head back further and lift the chin again.
• Repeat this procedure until help arrives or the person starts breathing again.
If an adult is unconscious and has no pulse
If an adult is unconscious, see if there is breathing. If not, start artificial respiration as described above.
Checking for a pulse
If you are inexperienced, you may waste valuable time checking for a pulse.
How to take a pulse
Place your fingers in the groove between the windpipe and the muscles of the side of the neck.
Press backwards here to check for a pulse.
If there is no pulse, or if you are unsure, then proceed without delay as follows.
1. Look at the person's chest and find the 'upside-down V' shaped notch that is made by the lower edge of the ribcage. Place your middle finger in this notch and then place your index finger beside it, resting on the breastbone.
2. Take the heel of your other hand and slide it down the breastbone until it is touching this index finger. The heel of your hand should now be positioned on the middle of the lower half of the breastbone.
3. Now place the heel of your other hand on top of the first. Keep your fingers off the chest, by locking them together. Your pressure should be applied through the heels of the hands only.
4. Keep your elbows straight, and bring your body weight over your hands to make it easier to press down.
5. Press down firmly and quickly to achieve a downwards movement of 4-5cm, then relax and repeat the compression.
6. Do this 15 times, then give artificial respiration twice. Continue this 15:2 procedure until help arrives.
7. Aim for a rate of compression of about 100 per minute. You can help your timing and counting by saying out loud 'one and two and three and four ...' etc.
If a baby (up to 1 year) is unconscious and has no pulse
• Find the place between the nipples where the ribs meet in the breastbone. Move your fingers about 2cm to the right from this point - just above their heart.
• Press firmly, but not forcefully, with your index and middle fingers.
• If you can't see the baby's chest rise, the pressure is not correct. But with babies, it is especially important to prevent further injury by taking care not to press too hard.

FIRST AID

First aid - what everybody should know
Reviewed by Dr Stuart Crisp, specialist registrar
Why learn first aid?
WARNING!
This advice is a general guideline for use in an emergency.
It is not intended to replace professional classes in first aid and resuscitation.
First aid is an important skill. By performing simple procedures and following certain guidelines, it may be possible to save lives by giving basic treatment until professional medical help arrives.
Remember, too, that practice makes perfect. In an emergency there is no time to read instructions. If you've memorised some of the basic procedures, it will help you react quickly and efficiently.

ACCIDENT FIRST AID TREATMENT(Stings and insect bites)

Reviewed by Dr John Pillinger, GP
Insect bites often cause one or more red bumps that are usually itchy and sometimes painful. Often there is a small hole in the middle of the bite, perhaps with the end of the sting sticking out. Apart from this local irritation, the bite is not usually dangerous provided the victim is not allergic to insect bites.

Bee and wasp stings are more likely to cause allergic reactions than other kinds of insect bites.
What are the sources of insect bites?
The sources of insect bites are recognised to be wide and varied.
Insects, such as fleas can be found on domestic pets, eg dogs and cats; and also on birds.
Bedding and other soft furnishings around the house can also harbour bed bugs and fleas.
About 95 per cent of the fleas on a pet will be in the form of eggs, larvae and pupae (ie in the household) rather than on the animal.
Simply working in your garden can expose you to fleas and other insects.
Travelling can also put you at risk. Depending on your destination – exposure to mosquitoes, ticks and sandflies can occur.
Which insects cause stings or bites?
Stings or bites are caused by midges, horseflies, bees, wasps, ants, some spiders, fleas, lice, etc.
What does a bite look like?
There will be one or more swollen red bumps on the skin. In the middle, you will often see a small hole, which might have the insect's sting sticking out of it.
If you wake up in the middle of the night having noticed a painful or itchy lump, check to see if other parts of the body are affected. If there is only one bump, or four or five of them close together, you have probably been stung or bitten. Fleas often bite four or five times in the same area so you may find a couple of these clusters on your body.
Some children's diseases can also cause bumps and red, swollen skin. If in doubt, consult your doctor.
What are the symptoms of insect bites?
The skin becomes red, swollen, itchy and can be painful. These are the most common symptoms. Sometimes bites cause an allergic reaction. Bites can become infected by scratching. Look out for a rash or swelling that gets worse instead of better. If this happens, see a doctor.
Call your doctor immediately if you notice any of the following symptoms:
• the person has been stung by many insects at the same time
• a rash or swelling that gets worse instead of better
• if the site is red, tender and swollen
• headache
• dizziness
• nausea (feeling sick)
• pains in the chest
• choking or wheezing
• difficulty breathing.
These may be symptoms of allergy and can be life-threatening if the victim goes into shock. See a doctor immediately or dial 999 for an ambulance.
How to treat an insect bite or sting
Remove the sting. Use tweezers to prise it out or scrape it off with your fingernail, or a credit card. Do not attempt to press out the sting, as this will only help the poison spread under the skin.
Wash the bite with soap and water, then cool off the skin with ice cubes or an ice-pack that has been wrapped in a cloth or thin towel. Rest the affected area and elevate it if possible to prevent excessive swelling. Do this immediately after the victim has been stung.
If necessary, use a painkilling cream or gel or an antihistamine to soothe the itch. If you or a member of your family are allergic to insect bites, talk to your doctor or pharmacist before going on holiday. They may tell you to take an antihistamine with you in tablet form; or Adrenaline or as an EpiPen injection. If so, make sure you ask how to use them correctly.
Anyone who gets a rash or an itch requiring medical treatment, or who may simply feel unwell following a bite or sting should not drive, as there is a risk of passing out. If in doubt, consult your doctor.
Insect bites and allergies
People who are allergic to insect bites should carry a card, bracelet or necklace that lets other people know about their allergy. If the doctor has prescribed medication for you to be used in case of an allergic reaction, it is important that both you and your family know exactly how to use it.
How to avoid getting stung
• If surrounded by a swarm of bees or wasps, move out of the way slowly. Do not try to wave the insects away. Violent movements will only excite them and make them more aggressive and likely to attack.
• Insect repellents are effective.
• Never aim a blow at a wasps' or bees' nest or attempt to throw them because the insects will immediately attack.
• Stay away from things that attract insects, such as flowers, trees, bushes and piles of wood.
• Be extra careful if you are eating or drinking (especially sweet things) outside.
• Smells and bright colours attract insects. Avoid scented creams and strong perfumes if you are going to spend time outside.
• Long sleeves, long trousers, socks, shoes and gloves help protect you from stings.
• Close the windows in the house and the car to keep the insects out.
• Look out for insects' nests in your home or garden and have them removed immediately.
• Protective gear such as mesh covers for the face can be very effective against the nuisance of the highland midge in summer for example.

ACCIDENT FIRST AID TREATMENT(Poisoning in children)

Reviewed by Dr Stephen Greene, consultant paediatrician
Poisoning accidents
Accidents in the home are much too common, especially since many can be avoided by taking a few simple precautions.
Some of the more serious accidents are poisoning incidents involving children. When young children explore the world, they use all their senses including taste. They typically put everything in their mouth to find out what it is. For this reason, adults must make sure that children do not have access to anything poisonous.
It is surprising just how many ordinary household articles are dangerous in this respect. To make your home safe from poisoning, examine it carefully one room at a time. Identify any potentially harmful substances and either lock them away or store them somewhere out of your children's reach.
What is poisonous in the kitchen?
Cleaning materials are usually kept in the kitchen, often in a low cupboard under the sink where they are easily accessible to curious children. Potentially dangerous products include:
Think...
...about the appearance of the containers. Chemicals and detergents often come in colourful containers which appeal to small children, while the scent of some detergents also tends to be attractive.
As strange as it may seem, nasty tastes don't seem to put children off experimenting further.
• all kinds of detergents and cleaning products, which often contain chemicals that are poisonous to children.
• plant fertilizer. This is extremely dangerous.
• detergents used in automatic dishwashers. These are highly caustic and, therefore, very dangerous if consumed.
Move these products to a locked cabinet where children cannot see or reach them. It's not enough to simply store them on a worktop since children are excellent climbers. Buy products with childproof lids wherever possible - but lock them away nonetheless.
Never pour chemicals or detergents into empty soft drink or water bottles. Children may think the bottles still contain the original liquid.
What is poisonous in the bathroom?
Medicines, cosmetics, creams and lotions contain harmful substances (such as alcohol) that may poison a child.
Many tablets, medicines, herbal remedies and even vitamins are dangerous for children. Remember that children are less tolerant than adults and even a small quantity may be poisonous.
Always keep such items in a locked cabinet that the children do not have access to. Put any medicines back in the cabinet immediately after use.
What is poisonous in the living room?
Alcohol is very dangerous for children. Always lock cabinets containing wine and spirits - screwing down the lids tightly is not enough. Children are very good at opening things and even a small amount of alcohol can be harmful to a young child.
Remote controls for electronic equipment may contain small mercury batteries, which can cause poisoning if swallowed.
Cigarettes and tobacco are often left lying around. Tobacco, in all forms, is an extremely dangerous poison and just one cigarette stub may poison a child. All kinds of tobacco should be kept out of the reach of children.
Are plants poisonous?
Many houseplants and garden plants are poisonous if eaten.
A pharmacist can provide advice about poisonous plants. If you have small children, do not keep any poisonous houseplants - even if you place them out of reach, leaves may fall to the floor.
Plant poison often causes blisters and/or ulcers in your child's mouth or their tongue may start swelling.
What is poisonous in the garden?
Check which of the plants growing in your garden may have leaves, berries, flowers or fruit that could poison a child.
A garden shed is likely to contain decorating materials, paint, methylated spirits, turpentine, plant fertilizer, weedkiller, barbecue fire lighters and many more substances that are all extremely poisonous. Garden sheds should be locked at all times.
Guests
When you have guests politely ask them not to leave cigarettes or medicines where your children can get their hands on them.
Be vigilant when taking your child to visit friends - particularly those who don't have small children themselves and may not be aware of the potential hazards around their home. Find a diplomatic way to suggest that your hosts move any toxic substances to a safe place - tell them, if you like, that you're child is particularly curious and has a tendency to open interesting-looking bottles. Keep an eye on your child at all times.
What if my child is poisoned?
Try to stay calm and call a doctor immediately. The doctor will need as much of the following information as possible.
• What did the child eat/drink? Write it down.
• How much? Find out whether it is one tablet or half a bottle.
• The doctor will ask you what the child weighs.
• If you are going to Accident & Emergency, take some of the substance that your child has eaten/drunk.
Which medicines are used?
Inactivated charcoal is often used in hospital emergency departments as an antidote in cases of poisoning. Large doses are used to prevent the poison being absorbed from the stomach. Inactivated charcoal tablets are available to buy from pharmacies, but these are for the treatment of indigestion and flatulence only and should not be used at home to treat poisoning, as the dose they contain is far too small.
For this reason you shouldn't keep charcoal tablets as poisoning treatment in your first-aid kit. You should always consult a doctor or hospital emergency department in cases of poisoning.
In some cases of poisoning your doctor will recommend that you give your child milk. But only do this if the doctor has advised it.
Induced vomiting - or forcing your child to throw up - is necessary only in some cases of poisoning. Do it only if you know exactly what has poisoned the child and the doctor has told you to go ahead. If your child has swallowed a caustic substance it could be extremely dangerous for them to vomit, so always get medical advice first.
How can I protect my child
Although it is important to keep an eye on your children as much as you possibly can, it is simply not possible to know what they're up to 100 per cent of the time. For this reason, when it comes to preventing poisoning, the most important and practical measure is to ensure toxic substances are completely out of reach in the first place.
Make a thorough check of your house and garden, removing any harmful products and placing them in a securely locked cabinet.

ACCIDENT FIRST AID TREATMENT(Foreign body in the eye )

Reviewed by Dr Caroline MacEwan, consultant ophthamologist and Dr Whye Onn Ho, specialist registrar
Any material such as dust, sand or paint that gets into the eye is called a foreign body. Foreign bodies fall into two categories.
• Superficial foreign bodies: these stick to the front of the eye or get trapped under one of the eyelids, but do not enter the eye.
• Penetrating foreign bodies: these penetrate the outer layer of the eye (cornea or sclera) and enter the eye. These objects are usually travelling at high speed and are commonly made of metal.
How do you get foreign bodies in the eye?
Non-perforating superficial foreign bodies are generally either blown or fall into the eye. This may occur, for instance, when working under a car or when outside on a windy day.
Penetrating eye injuries tend to occur when people are hammering or grinding. Under these circumstances small pieces of metal travelling at high speed hit the eye and enter it through the outer coat of the eye.
Is it a serious condition?
Superficial foreign bodies are not usually serious.
A penetrating eye injury can be extremely serious - it may lead to blindness if not detected and treated promptly. Even if treated appropriately, it may cause loss of vision.
What does it feel like?
Superficial foreign bodies tend to be very uncomfortable. The foreign body may be stuck on to the cornea or the conjunctiva, causing a red, watery and gritty eye.
The foreign material may have become stuck under the upper lid, whereby every time the eye opens and closes the pain increases.
Penetrating eye injuries, although they are much more serious injuries, paradoxically are often much less painful. The vision may be reduced, but this is not always the case.
How can I get rid of a foreign body?
If you get a superficial foreign body in your eye, first-aid treatment in the form of gentle rinsing with warm water is appropriate. An 'eye bath' can make this easier to do on your own, or you can get someone to help rinse the eye from the side, with you lying down.
Do not try to remove a foreign body with cotton buds, matchsticks or any other type of solid object. You could do more harm than good - go to the nearest casualty doctor or contact your GP's surgery.
It is also advisable to consult a doctor if you think you've had a foreign body in your eye and it's continuing to cause irritation.
If you think something has gone into your eye while you have been grinding or hammering, even if you have little in the way of pain or loss of vision, it is essential that you consult a doctor immediately and tell them about the circumstances of your injury.
How does the doctor make a diagnosis?
Superficial foreign bodies
If you tell your doctor you have felt something going into your eye, he or she will examine the eye using a fluorescein stain, which helps to detect any foreign material on the surface of the eye.
The eyelid also needs to be turned outwards so that the underside of the lid can be examined and any foreign material removed from that surface.
The material can be removed using a cotton bud, although occasionally a small needle may be required to lift any embedded particles from the eye. This is carried out with local anaesthetic drops and does not hurt.
Penetrating foreign material
Good advice
Wear protective glasses or goggles to prevent foreign bodies entering your eyes.
For example, when:
• welding
• using a grinder
• using a sander
• using a Strimmer
• doing DIY.
If you tell your doctor that you have suffered a possible eye injury while carrying out a high-risk activity such as hammering, the eye will be examined in full detail.
Your vision will be assessed, and it is possible that this may be reduced. There may be evidence that the pupil is distorted and there may be blood inside the eye.
If the lens of the eye has been hit by the foreign material, there may be evidence of an early cataract.
X-rays or scans may be required if there is any suspicion there is foreign material inside the eye.
What happens if the foreign body is not removed from my eye?
Superficial foreign material
This will tend to cause persistent irritation and may lead to conjunctivitis. Sometimes the foreign material becomes buried and stops causing problems, although there may be some scarring.
Penetrating foreign bodies
The damage caused by an intraocular foreign body depends on:
• the type of material that makes up the foreign body
• the amount of damage it causes as it passes into the eye.
Metal foreign bodies that have iron in them can cause a condition called 'siderosis', which gradually leads to poor vision over the following months and years.
Some other metals and vegetable materials may cause rapid destruction of the eye or infection inside the eye.
It is possible for a small foreign body to enter the eye and cause no apparent damage, but it may lead to bleeding within the eye, early cataract formation or damage to the retina. Surgery may be required to correct this damage.
How is a penetrating foreign body removed?
An operation is needed to remove foreign bodies that have penetrated inside the eye. This usually takes the form of a vitrectomy, which involves going into the eye to remove the foreign material with fine surgical forceps.
At the same time, any damage to the eye caused by the entry of the foreign material can be repaired. This may involve removal of haemorrhage, removal of the lens, suturing of any defect of the globe or repair of retinal damage.
Will there be any long-term effects?
Superficial foreign bodies are not sight-threatening injuries and the eye tends to make a full recovery. However, if there are recurrent episodes, scarring can occur which causes deterioration of vision.
Penetrating foreign bodies are potentially very serious and may lead to blindness or loss of the eye, even if treated appropriately.

ACCIDENT FIRST AID TREATMENT(Sprained ankle)

Reviewed by Dr John Pillinger, GP
How do you sprain an ankle?

A sprained ankle happens when the ligaments have been damaged by the joint being twisted.
When you twist your foot or ankle, it usually twists inwards damaging the ligaments on the outside of the ankle. Outward twists damaging the inside ligaments are rare.
The majority of cases are sports injuries but a sprained ankle can also happen in everyday life.
If you do not receive the appropriate physiotherapy treatment and allow the injury time to recover you will be more likely to sprain the area again.
What does a sprained ankle feel like?
A sprained ankle can be very painful. But the speed of onset and the severity of the pain can vary greatly.
Sometimes, the pain can be delayed, at other times it is instant. The level of pain is not always a measurement of the extent of the damage. Some people hear a 'pop' in their ankle. This could suggest a torn ligament. The twist is followed by swelling of the area.
Rapid, significant swelling usually indicates severe damage has taken place. The swelling is caused by bleeding of the damaged tissue and the resultant bruise or discolouration is a result of gravity pulling the blood downwards. So the swelling is often situated a small distance away from the actual damaged site.
What are the danger signs?
There are no actual danger signs but after a sprain you may feel your ankle is unstable, you may have problems controlling it, or you may have balance problems when standing on the affected foot. In these circumstances, it is essential to get advice about appropriate physiotherapy treatment and exercise.
If you have persistent pain and a feeling of instability, you may have sustained damage other than a sprain. These symptoms need further assessment by a doctor.
What can be done at home?
Injuries of this kind should receive first aid treatment following the RICE principle, which stands for Rest, Ice, Compression and Elevation. Cooling the injury as fast as possible will reduce the swelling and pain.
Rest
The injured foot must be rested for the first 24 to 48 hours to prevent any further injury.
Ice
The damaged area must be cooled by using an icepack or a packet of frozen peas. The ice must never have direct contact with the skin or the patient could get frostbite. A cloth should be placed between the ice and the skin. Ice can be laid on the affected area for up to 20 minutes every hour, but for no longer than three hours in all. Ice treatment has been known to be effective for up to 24 hours after the injury occurred.
Compression
The compression must be firm but not too tight. It must not be allowed to affect the blood circulation. An elasticated bandage from the toes to the middle of the lower leg would be ideal.
Elevation
The foot must be elevated above heart level. It is most comfortable to lie down and elevate the limb with a few pillows. If you are sitting down, the legs can be raised on a chair or a table. This elevation should be maintained for a few days.
How does the doctor make a diagnosis?
The doctor will assess the degree of swelling and the extent of the damage and whether the tenderness corresponds to the position of the ligaments or bones. Finally, any weakness of the ankle will be assessed.
If a fracture is suspected, an X-ray examination will be necessary.
Future prospects
Depending on how bad the damage is, these symptoms will usually go away between one and four weeks after the accident.
The immediate tenderness can persist for one to four weeks, depending on the extent of the damage. Support-related pain can persist for up to three months.
With the correct approach, there will rarely be any lasting symptoms but a small number of people have ongoing pain and a feeling that their ankle is weak. If this is the case, further investigation may be needed to find the cause of any ongoing symptoms.
For a more severe sprain, you need physiotherapy and you should not do any sports training for at least six weeks.
Treatment
The primary treatment by RICE is adequate to achieve recovery following minor sprains.
When receiving treatment, it's important to give the physiotherapy time to work. The patient must avoid damaging the ankle further by not allowing it to bear too much weight too early.
The physiotherapy is aimed at starting to move the foot after one or two days. After this, a lot of balance training is required, on the floor and using other apparatus such as a wobble board or seesaw board or a trampoline. This is important to restore the stability of the ligaments.
In addition, strength must also be restored to the joint by training. Later in the recovery period more complicated running patterns can be attempted such as running zigzags, figures of eight and so on.
If the ankle is not allowed to mend properly, sportspeople often complain of loose joints or ligaments. This is almost always avoidable by patience and rehabilitation. It is better for sportspeople to be able to concentrate 100 per cent on their sport rather than on their fear of another injury due to lack of careful rehabilitation training.
What medication can be used?
The doctor may prescribe a non-steroidal anti-inflammatory drug such as ibuprofen (eg Brufen).
Your doctor or pharmacist will also be able to advise you about creams, gels and support bandages which can be used to treat minor sprains and be bought from a pharmacist without a prescription.

ACCIDENT FIRST AID TREATMENT(Penile injury)

Written by Dr Geoff Hackett, consultant in sexual dysfunction
What is penile injury?
Injury or trauma to the penis can be accidental or deliberate.
Deliberate penile injury is a particularly violent event that is usually self-induced, or inflicted by a jealous partner or their former lover.
Despite the publicity surrounding a case of penile amputation in the USA, deliberate penile injury is rare in Western cultures, but seen more often in the Far East. Common injuries are:
• penile amputation
• penile fracture.
Fracture of the penis
Fracture occurs when an abnormal force is applied to the erect penis. The 'fracture' is actually a tear in the tunica albuginea, the thick fibrous coat surrounding the corpora cavernosum tissue that produces an erection. It is an uncommon injury, usually but not always the result of damage to the penis during sexual intercourse. Most cases (75 per cent) occur on one side, 25 per cent affect both sides and in 10 per cent the tear extends into the urethra.
What are the symptoms of penile fracture?
• A 'cracking' noise.
• Pain.
• Bruising.
• Immediate loss of erection.
Bleeding from the urethra may occur if the urethra is damaged.
How is penile fracture treated?
Advice should be sought quickly. Key elements in treating a fractured penis are:
• pain relief
• ice packs (always cover with a cloth before applying to skin)
• support
• anti-inflammatory drugs.
This regime has satisfactory results in about 80 per cent of patients but in the rest, residual pain and deformity may lead to difficulty with sex. These patients need a urethrogram (a test that shows whether the urethral tube is intact) to exclude urethral damage.
If the urethra is not damaged, any collection of blood (haematoma) is drained and repair is carried out to the damaged corpora and tunica. One report of a series of 17 repairs showed that after surgery all patients had painless erections and comfortable sex; only two patients were left with angulation ('bent' penis).
Urethral injuries should always be repaired but urethral stricture (narrowing) occurs long term in up to 20 per cent of men after surgery.
Penile amputation
The traumatic removal of part of the penis, or the entire penis, is usually associated with severe rage, jealousy or psychiatric disturbance.
Acute blood loss may be considerable and life threatening, particularly with amputation of the erect penis. Successful outcome of surgery is closely related to the viability (capacity to stay alive) of the severed portion, so the part should be recovered and surgical advice sought as quickly as possible.
The aim of surgery is to restore penile length and the different functions of the penis if possible. Because the nerves to the erectile tissue are not usually damaged, erectile function is frequently maintained.
Microsurgery (fine surgery done with the surgeon looking down a microscope) is necessary to restore any degree of feeling. Compared with other forms of reconstruction, microsurgery offers the best chance of having an adequately functioning urethra (tube in the penis used for urination and ejaculation).
Particular care must be taken to reconnect the veins, especially the deep dorsal vein, to restore venous drainage and prevent swelling and compromised blood flow after the operation.

ACCIDENT FIRST AID TREATMENT(Nosebleeds (epistaxis))

Reviewed by Dr Robert Mills, consultant otolaryngologist
Where does the blood in a nosebleed come from?
The blood usually comes from a blood vessel located in the front of the nasal septum (nasal partition) or further back in the nasal cavity.
What can cause a nosebleed?

• Picking the nose.
• A blow to the nose or damage to the mucous membrane.
• A cold or flu.
• A nasal allergy.
• Dry mucous membranes in the nose due to a stuffy indoor atmosphere.
• Hypertension (high blood pressure) - rarely.
• Certain kinds of medication; for instance, products that reduce the viscosity of the blood (such as aspirin (eg Micropyrin) and non-steroidal anti-inflammatory drugs).
• Exposure to chemicals that may irritate the mucous membranes.
• Deviation of the nasal (septum).
Most nosebleeds occur for no obvious reason.
Other rare causes of nosebleeds
• Blood diseases such as leukaemia or haemophilia.
• Tumours in the nasal cavity.
• Osler's disease.
Danger signals in a severe nosebleed
• Heavy bleeding.
• Palpitation, shortness of breath and turning pale.
• Swallowing large amounts of blood, which will cause you to vomit.
How to avoid nosebleeds
• Avoid damaging the nose and excessive nose-picking.
• Seek medical treatment for any disease causing the nosebleeds.
• Get a humidifier if you live in a dry climate or at high altitude.
What to do if you get a nosebleed
• Sit in an upright position with your head bent forward.
• Hold the tip of your nose for five minutes while breathing through the mouth.
• If the bleeding stops and then returns, hold your nose for 8 to 10 minutes. This will allow time for the blood to clot.
• Applying an ice-pack to your nose may help.
Good advice
• Do not blow your nose for the next 12 hours after the bleeding has stopped. This will help the dried blood to remain in place.
• Do not swallow the blood. It can cause you to become nauseous and vomit, or could conceal a greater blood loss.
• If you frequently suffer from nosebleeds you should seek help from your doctor.
The most likely development
• The bleeding usually stops if you follow the above instructions.
• Heavy bleeding may require hospital treatment and, in rare cases, a blood transfusion.
How is heavy bleeding treated and what kind of medication can be given?
Contact your doctor if the advice described above does not help stop the bleeding.
Initially, the doctor will try to stop the bleeding by using something that will make the blood vessels contract.
When the bleeding has stopped, the doctor may choose to cauterise the source of the bleeding with a chemical to prevent it bleeding again.
If the bleeding fails to stop, it may be necessary to put a pack in the nose.
In rare cases, an operation may be necessary to tie off the blood vessel that supplies the bleeding area.
If the bleeding is caused by another disease, such as increased blood pressure, it is very important to seek treatment to avoid recurrence of nosebleeds.
Nosebleeds can be very intermittent, and between bleeds it may be very difficult to determine their source. If this occurs it is best to ensure that the nose is inspected during a bleed, which might mean needing to be assessed 'out of hours' by the on-call GP or local casualty unit.

ACCIDENT FIRST AID TREATMENT(Heart Stroke)

Heatstroke
Written by Dr Charlie Easmon, specialist adviser in travel medicine
What is heatstroke?
Heatstroke is a condition in which the body becomes overheated in a relatively short space of time. This can be a life-threatening condition, requiring urgent medical attention.
Abnormally high body temperatures (hyperthermia) may occur in several different circumstances, such as:
• classic heatstroke (also called sunstroke: a little misleading because the condition can arise without the direct effect of the sun) when, typically, the skin is flushed, red and dry.
• heatstroke caused by exertion, which often occurs in conjunction with pronounced physical exertion, eg sports activity.
• in extensive burns (including sunburn), where the sweat glands have been damaged or destroyed.
• in a number of less common medical conditions, such as overactivity of the thyroid gland (thyrotoxicosis).
The first three in the list are of special interest to the traveller.
When can heatstroke occur?
Heatstroke occurs when the body cannot dispose of excess heat in the normal way. Heatstroke and fever can be distinguished as follows:
• fever, in which the body's mechanism for regulating temperature is functioning and set at a higher level. The patient is, typically, flushed and bathed in sweat.
• primary hyperthermia (for instance, heatstroke), where temperature regulation is either partially or totally out of action. The patient often sweats only a little or not at all and the skin is flushed red, hot and dry.
What puts the traveller at risk of suffering heatstroke?
• Surroundings with high temperature, high humidity and strong sunlight (typically in the tropics).
• Too much physical exertion (eg sport), particularly in the above conditions.
• Extensive sunburn, particularly in a hot and humid climate.
• Lack of fluids/salt in hot (particularly tropical) surroundings.
• Excessive alcohol consumption under the same conditions.
What can you do to help yourself?
• It is important to get used to heat and humidity slowly, particularly before physical exertion. This acclimatisation to the tropics can typically take one to three weeks.
• Make sure you drink plenty of salty liquids (at least 3 to 5 litres a day, but not alcohol). In very hot conditions you may need to drink much more and a good tip is to start the day by drinking at least two litres!
• Make sure you supplement your salt intake (for example by eating crisps and/or taking salt tablets).
• Wear light, airy, loose-fitting clothing (light cotton).
• Be careful if you undertake any hard physical exertion, particularly if your fluid/salt intake is low.
• Stay in the shade or, if possible, in an air-conditioned environment.
• Take frequent dips in cool water (sea or pool), particularly if you are sunbathing a lot.
When does heatstroke become critical?
• Body temperature around 41°C (measured in the rectum).
• You feel increasingly unwell, tired and dizzy, and your head may hurt and you may feel 'distant'.
• If your skin becomes flushed red and dry (ie perspiration is reduced or not functioning).
• You produce less urine, which is of a dark yellowish colour (which indicates a shortage of fluid).
• You become less alert, with a tendency to faint, and experience confusion, impairment or loss of consciousness and convulsions.
• At temperatures above 41°C the situation starts to be serious. At temperatures above 42°C cell damage to the brain, liver, kidneys and skeletal muscle often occurs as well as bleeding disorders.
Therapy
If a person suffers from heatstroke it is important to put them in the shade and preferably in a cool environment (ideally an air-conditioned room at a temperature of 15 to 18°C).
• The patient should be undressed and made to lie naked, or covered only by a thin sheet.
• If the patient's temperature rises to 39.5°C, and the skin is still dry and burning hot (or with only very slight sweating) they should be showered with cool water (15 to 18°C). You can also put the person in a bath of cool water while massaging the skin to increase circulation. Another possibility is to cover the patient with wet sheets or towelling, changing them often, preferably in combination with an electric fan, or something similar, to bring the temperature further down.
• Do not use water cooler than 15°C because this will restrict heat loss as the blood vessels in the skin will contract.
• If possible the patient should be taken to a doctor, or better still a hospital, as soon as possible. A person with heatstroke often needs oxygen, a drip (fluid infusion into a vein) and sometimes medication.
Who is particularly at risk of suffering heatstroke?
• Elderly and often weak or fragile people with a low fluid level.
• People who are overweight.
• People with cardiovascular or lung diseases.
• People taking certain types of medication, such as anticholinergics (which prevent sweat production) and beta-blockers (which reduce the blood circulation to the skin).
• Infants and small children.
• Pregnant women (particularly if their fluid/salt levels are low).
• People under the influence of alcohol.
• People who play a lot of sport without taking sensible precautions, such as drinking plenty of fluids.

ACCIDENT FIRST AID TREATMENT(Dental Injuries)

Dental injuries
Reviewed by Ms Lisa Taylor, dentist
What are dental injuries?
Dental trauma occurs when the tooth receives a blow. Teeth can be broken, loosened or knocked out completely. Immediate treatment gives the best possible chance of saving the tooth.
What should you do about dental injuries?
Following an accident involving the face/mouth:
• check the teeth by looking, or using a finger.
• locate any missing teeth or fragments of teeth.
• only touch the crown of the tooth - the part usually visible in the mouth.
• do not wash or rinse the fragment or tooth with anything, even water.
• store the fragment or tooth in milk, if possible. If the person is conscious, not shocked and old enough to cooperate, the fragment can be stored in their mouth under the tongue.
• seek advice from a dentist immediately. A tooth that has been knocked out, or even a broken tooth, has a better chance of being successfully re-implanted if this is done as soon as possible (ideally within half an hour).
What can your dentist do?
• It may be possible to re-implant the tooth if help is sought quickly, the bone is not too badly damaged and the patient is in a fit state for treatment.
• Milk teeth are not re-implanted as there is a risk of harming the permanent tooth underneath.
• Soft tissue damage may require stitches.
• The tooth fragment or a white filling material may be used to rebuild the tooth.
• A splint is often required to hold a loosened or re-implanted tooth in place.
• A tetanus booster and/or antibiotics may be required.
• The tooth will need to be regularly checked and X-rayed.
References
Health Evidence Bulletins Wales: Oral Health. Chapter 7: dental injuries. Welsh Office, 1998

ACCIDENT FIRST AID TREATMENT(Concussion)

Concussion
Reviewed by Dr Dan Rutherford, GP
What is concussion?
Concussion is a disturbance of function of the nerve cells in the brain as a result of a blow to the skull. This means that parts of the brain's functions are temporarily 'on hold'.
The symptoms include temporary unconsciousness, headache and, often, a loss of memory concerning the critical incident. Vomiting and nausea are also common.
All blows to the head may be dangerous
An uncomplicated concussion is not dangerous and cannot be treated. The brain will simply need time to heal. But complications can arise in severe cases:
• A blow to the head can cause a tear of a blood vessel under the skull and thereby cause a growing accumulation of blood that will gradually cause the brain to become displaced. This condition is life threatening if the blood accumulation is not drained by drilling a hole in the skull.
• A very serious concussion with several days of unconsciousness is also dangerous owing to the risk of the brain swelling.
The doctor should be contacted if:
• the patient has been unconscious for more than a couple of minutes.
• the patient, after having regained consciousness, becomes sleepy and hard to converse with.
• the patient's condition worsens after improvement.
• the patient vomits.
• the patient has a fit.
When will a doctor send a concussed person to hospital?
The doctor will admit the patient to hospital for observation for 24 hours if there has been unconsciousness. If the concussion is less severe and the home circumstances are adequate then observation at home may be satisfactory.
What to look for in a concussed person
In general, the patient should be watched by an adult for 12-24 hours after the incident. Once every hour the patient should be asked to repeat something simple like their name and address, even during the night.
If the patient is unable to remember simple personal details, the doctor should be contacted immediately.
What to do after a concussion
Usually the symptoms disappear gradually after a few days or a few weeks. Some points to remember:
• the brain needs to rest until the injures have healed and it should be strained as little as possible. Avoid too much reading or watching TV.
• hard physical activity should be avoided in the first week.
• get plenty of physical rest.
Is there a risk of permanent injury?
If the concussion has been particularly severe or the patient does not rest, there is a risk that the symptoms may stay for months and, in a few instances, the injuries become permanent. There is also a small risk of developing epilepsy after a concussion. The risks are particularly high when the concussions occur repeatedly, ie in boxers. This condition can be very uncomfortable, and is also called post-traumatic cerebral disorder. Many suffer from heavy headaches, dizziness, tiredness, irritability, sensitivity to sound and a lack of ability to concentrate. They may also feel uncomfortable when consuming alcohol.
If you recognize these symptoms you must consult a doctor.
Generally, the younger the patient, the better the chances of a complete recovery.
'Post concussion' syndrome more commonly follows a mild head injury and includes: headaches, dizziness, difficulty in breathing, depression and anxiety.
This syndrome can develop even if brain damage is minimal or absent on investigation.
All head injury patients require adequate medical assessment and for any other than minor injuries, this should be by a consultant in trauma medicine or a neurologist.

ACCIDENT FIRST AID TREATMENT(BURNS)

Burns
Reviewed by Dr Stephen Collins, GP
What are burns?
Burns are skin damage caused by contact with fire, heat, electricity, radiation, or caustic chemicals.
Burns are classified according to the depth and extent of the skin damage, in the following way.
• First-degree burns: the skin is red, painful and very sensitive to touch. The damaged skin may be slightly moist from leakage of the fluid in the deeper layers of the skin.
• Second-degree burns: the damage is deeper and blisters usually appear on the skin. The skin is still painful and sensitive.
• Third-degree burns: the tissues in all layers of the skin are dead. Usually there are no blisters. The burned surface can appear normal, white, black (charred), or bright red from blood in the bottom of the wound. Damage to skin nerves can mean it is quite painless. The burned skin lacks sensation to touch. A skin graft is usually necessary for significant areas.
First aid for burns
The first thing to do is to limit the extent of the damage, and prevent the burn from becoming worse.
• The burnt area must be cooled by being placed under cold running water. The water must not be unpleasantly cold.
• The damaged area must stay under running water for at least one hour, or longer if the pain has not stopped. Up to four hours of this treatment can be beneficial.
• First-degree burns, eg mild sunburn, do not require this treatment.
Which burns need treatment by health professionals?
• Burns that are bigger than the palm of the hand.
• Burns on the face, neck, hands, and in the groin.
• All third-degree burns.
• Most second-degree burns.
Remember that it can be difficult to distinguish between second- and third-degree burns, so always have a nurse or doctor check all but the most minor burns.
• If possible, keep pouring water over the burn on the way to the doctor, or use clean, soaking wet towels.
• Do not lance the blisters yourself.
• Never apply an ointment to burns or try other folk remedies - water is the only thing that should be used. Do not use butter or lard on burns!
• Do not forget to have a tetanus injection if you have not had a booster within the last 10 years.
What complications can occur?
• When skin is burned, it loses its ability to protect, which increases the risk of infection. So it is important that the damaged area be thoroughly cleansed within the first six hours, and that the area is kept clean while it is healing.
If, after a few days, there are signs of an infection - ie the skin is becoming increasingly red, hot, and swollen, and the victim experiences a throbbing pain - contact a doctor or your practice nurse.
• Severe burns can cause scarring.
• In cases of extensive severe burns, the body may lose large quantities of fluid. This can disturb the blood circulation and cause problems with the body's salt balance. Such injuries should be assessed at your local Accident and Emergency department.
What can be done to prevent burns?
The kitchen is the most dangerous room in the house, and the most likely place for burns and scalds to occur.
When cooking, keep small children away from hot drinks, pans and kettles, barbecues and other open flames. Remember that barbecues can suddenly 'spit' flames when inflammable liquids are poured over them. Barbecues are a major cause of serious burns.
When there are small children in the house, fill baths by running the cold tap first.
Never throw water over oil fires, such as in a chip pan, because this will cause a fire explosion that can have severe consequences. Instead the fire should be smothered by covering the pan with a damp cloth.
Buy a proper fire-smothering blanket and keep it somewhere in the kitchen where it is easily accessible.

Tuesday, July 28, 2009

What causes drug abuse and addiction?

What makes one person abuse drugs to the point of losing their home, their family and their job, while another does not? There is no one simple reason. Drug abuse and addiction is due to many factors. A powerful force in addiction is the inability to self- soothe or get relief from untreated mental or physical pain. Without the self-resilience and support to handle stress, loneliness or depression, drugs can be a tempting way to deal with the situation. Unfortunately, due to the changes drugs make to the brain, it can only take a few times or even one time to be on the road to addiction. Some other risk factors include:
• Family history of addiction. While the interplay between genetics and environment is not entirely clear, if you have a family history of addiction, you are at higher risk for abusing drugs.
• History of mental illness. Drug abuse can worsen mental illness or even create new symptoms. See dual diagnosis for more information on mental illness and drug abuse.
• Untreated physical pain. Without medical supervision, pain medications or illegal drugs like heroin can rapidly become addictive.
• Peer pressure. If people around you are doing drugs, it can be difficult to resist the pressure to try them, especially if you are a teenager.
Signs and symptoms of drug abuse and addiction
How can I tell if I or a loved one has a drug abuse or addiction problem?
Although different drugs may have different effects on overall physical and mental health, the basic pattern is the same. Getting and using the drug becomes more and more important than anything else, including job, friends and family. The physical and emotional consequences of drug abuse and addiction also make it difficult to function, often impairing judgment to a dangerous level.
Physical signs of abuse and addiction
Drug abuse affects the brain and body directly. While high, the drug affects the entire body, from blood pressure to heart rate. Stimulants like cocaine and methamphetamine “amp up” the body, increasing blood pressure, metabolism and reducing the ability to sleep. Drugs like opiates and barbiturates slow down the body, reducing blood pressure, breathing and alertness sometimes to dangerous levels. Some physical signs of abuse and addiction include:
• Cycles of increased energy, restlessness, and inability to sleep (often seen in stimulants)
• Abnormally slow movements, speech or reaction time, confusion and disorientation (often seen in opiates, benzodiazepines and barbiturates)
• Sudden weight loss or weight gain
• Cycles of excessive sleep
• Unexpected changes in clothing, such as constantly wearing long sleeved shirts, to hide scarring at injection sites
• Suspected drug paraphernalia such as unexplained pipes, roach clips or syringes
• For snorted drugs, chronic troubles with sinusitis or nosebleeds
• For smoked drugs, a persistent cough or bronchitis, leading to coughing up excessive mucus or blood.
• Progressive severe dental problems (especially with methamphetamine)
Tolerance and withdrawal
Most abused drugs are not only mentally addictive but physically addictive as well. Tolerance is built up to the drug. More and more of the drug is needed to achieve the desired effect. As the body physically adjusts to the drug, trying to cut down or stop is unpleasant or even painful. These withdrawal symptoms, depending on the drug, can include shakes, chills, severe aches and pains, difficulty sleeping, agitation, depression, and even hallucinations or psychosis. Avoiding withdrawal adds to the urgency of keeping up drug abuse and increases drug dependence.
For a list of specific withdrawal signs for drugs, see Treatment for Drug Abuse and Addiction
Mental and emotional signs of abuse and addiction
Abuse and addiction also affect mood, as drugs are abused for the temporary good feelings they provide. These feelings can vary depending on the drug used. Some mental and emotional signs include:
• Cycles of being unusually talkative, “up” and cheerful, with seemingly boundless energy.
• Increased irritability, agitation and anger
• Unusual calmness, unresponsiveness or looking “spaced out”
• Apathy and depression
• Paranoia, delusions
• Temporary psychosis, hallucinations
• Lowered threshold for violence
Teenagers and drug abuse
It can sometimes be hard for parents to tell if their teenager has a drug problem. After all, teenagers are notorious for oversleeping, being argumentative and pushing boundaries, or wanting their own privacy and space. If you suspect your teen has a drug problem, look for marked changes in behavior, appearance and health. Is your teen suddenly having trouble in school? Does he/or she seem more and more isolated, or have a new group of friends? A teen with drug problems may spend a lot of time sleeping- or be keyed up or unable to sleep. Have you noticed that money or objects that could be sold for drugs seem to be disappearing? Do prescription drugs seem to be used up too quickly?
Effects of drug abuse and addiction
What makes drug addiction problems so challenging to face, as opposed to other mental or physical problems? Drug abuse affects the person’s life in many ways, including health, finances and stability. But it also affects the entire family, friends, colleagues-- and even the community. What’s more, the strong denial and rationalization of the person using drugs makes it extremely difficult to get help, and can make concerned family members feel like they are the problem.
Health, employment and crime
Those who abuse drugs have a greater risk for health problems down the road, from neglecting their own health to risk of infectious disease like hepatitis or HIV from sharing needles. Heavy drug use directly affects health as well, including lung disease, arthritis, heart problems, brain damage and death from overdose. Productivity at work often suffers, and eventually trouble keeping a job or even homelessness can occur. The urge to use is so powerful that criminal activity for money or more drugs can be a strong temptation.
Staying addicted: Denial and rationalization
One of the most powerful effects of drug abuse and addiction is denial. The urge to use is so strong that the mind finds many ways to rationalize drug use. Someone abusing drugs may drastically underestimate the quantity of drugs they are taking, how much it is costing them, and how much time it takes away from their family and work. They may lash out at concerned family members, making the family feel like they are exaggerating and overstating the problem. What makes this so frustrating for family members is the person abusing drugs often sincerely believes they do not have a problem, and can make the family member feel like the dysfunctional one.
This denial and rationalization can lead to increased problems with work, finances and relationships. The person abusing drugs may blame an “unfair boss’ for losing her job, or a ‘nagging wife’ for why he is increasingly going out with friends to get high. While work and relationship stresses happen to everyone, an overall pattern of deterioration and blaming others may be a sign of trouble.
Drug abuse and the family
Sadly, drug abuse and addiction doesn’t only affect the person abusing drugs. It affects friends, family and the entire society. Child abuse and neglect is much more common when there is drug abuse in the family. The abuser may neglect a child’s basic needs in the quest for more drugs, or lack of impulse control can lead to increased physical and emotional abuse. Drug abuse by a pregnant woman affects the developing baby’s health. Domestic violence also happens more frequently. Abusing drugs leads to higher risk of injuries and death to self and others in car accidents.
Family stress
If you have someone you love abusing drugs, it is an enormous emotional strain. You might feel obligated to cover for the abuser, cutting back from work to deal with the abuser’s problems— or working more to make financial ends meet. You might not be able to see friends and engage in hobbies, as coping with the abuse takes more and more time. The shame of drug abuse in the family stops many family members from asking for help, instead pretending nothing is wrong. The emotional toll can be overwhelming. Children are especially sensitive.
When someone you love has a drug abuse or addiction problem
You may not immediately realize that someone you love has a drug problem. It may have started slowly, and your loved one might also have tried to hide the extent of the drug use from you. You might have gotten so used to the drug abuse that coping with it seems almost normal. Or the realization that there is something seriously wrong is almost too painful to admit. Don’t be ashamed, and you are not alone. Drug abuse affects millions of families, from every socioeconomic status, race and culture. There is help and support available.
What the person abusing drugs might say if you confront them about their usage
“I can get sober any time I want to. I’ve done it lots of times”. The key to recovery is staying sober, not constantly cycling through the process. Even if the person abusing drugs is able to resist for a little while, usually the cravings are too strong to resist during times of stress.
“Why do you exaggerate so much? I’m hardly using at all!” Remember denial is a key part of drug addiction. The person using drugs might actually believe they are not using as much as they are.
“It’s your fault. If you wouldn’t stress me out so much, maybe I wouldn’t need to use drugs as often” It is never your fault that someone is using drugs. Even if they are feeling stressed, there are other coping skills they can choose to use.
Understanding what is involved in recovery
• You cannot force someone you love to stop abusing drugs. As much as you may want to, and as hard as it is seeing the effects of drug abuse, you cannot make someone stop using. The final choice is up to them. The right support can help you make positive choices for yourself, and balance encouraging your loved one to get help without losing yourself in the process.
• Don’t expect your loved one to be able to quit without support. Withdrawal symptoms can be unpleasant, painful, and even deadly. While medical input is always a good idea, if your loved one is addicted to benzodiazepines or is a heavy drinker, withdrawal can be dangerous and should be done under medical supervision.
• Recovery will be an ongoing process. Someone who abused drugs will not suddenly be a cured person once sober. Drug use may have been masking painful feelings that will bubble up to the surface. Many in recovery experience depressed moods for up to a year or more as their brain reestablishes from the drug abuse. Learning new coping skills to resist cravings, and how to apply them in stressful situations, is an ongoing process. Ongoing support is crucial to work through those issues.
See Treatment for Drug Abuse and Addiction for more information on recovery and different treatment options.
Finding support
A good place to start looking for support is through local support groups. Listening to others with the same challenges can be a tremendous source of comfort and support. Al-Anon is a free peer support group for families coping with alcohol abuse. It may be a good place to begin as these groups are the most numerous, and frequently alcohol is abused with other drugs as well. Similar to Al-Anon, there are several support groups for families coping with specific drug abuse as well. These include Nar-Anon, for families coping with narcotic abuse, and Co-Anon, for families coping with cocaine abuse. Information about these groups can be found in Related Links below. Other sources of help and support include trusted friends, a therapist, or a pastor or rabbi.