First Aid

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First Aid
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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.

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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.

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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.
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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.

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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 recognise 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.

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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,
  e.g. 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).

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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.

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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 (e.g. 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.

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What can you do to help yourself?

• It is important to get used to heat and humidity
  slowly, particularly before physical exertion.
  This acclimatization 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.

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When does heatstroke become critical?

• Body temperature around 41C (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 (i.e.
  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 41C the situation starts
  to be serious. At temperatures above 42C cell
  damage to the brain, liver, kidneys and skeletal
  muscle often occurs as well as bleeding
  disorders.

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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 18C).
• The patient should be undressed and made to lie
  naked, or covered only by a thin sheet.
• If the patient's temperature rises to 39.5C, and
  the skin is still dry and burning hot (or with
  only very slight sweating) they should be
  showered with cool water (15 to 18C). 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 15C 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.

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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.

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Whiplash

• Whiplash occurs when the soft tissue in the spine
  is stretched and strained after the body is
  thrown in a sudden, forceful jerk. The injury
  most commonly occurs in car crashes involving
  sudden deceleration, but the injury can also
  occur in other strenuous physical activities such
  as diving.

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What does whiplash feel like?

• The most frequent complaints are headaches and
  stiffness in the neck and the back of the head.
  These symptoms appear within the first couple of
  days after the accident and usually pass after a
  few days to a few weeks.

Is whiplash dangerous?

• A doctor or hospital should be alerted if the
  patient experiences memory loss or periods of
  unconsciousness after a collision. This is
  especially the case if the patient experiences
  severe pains in the back of the head, pins and
  needles in the shoulders and arms or notices a
  sensation of heaviness in the arms.

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Is there anything the patient can do about
whiplash injury?

• In the first 24 hours after the injury, an ice
  bag applied to the neck will help to relieve
  inflammation. Bags of frozen peas make
  particularly good ice packs because they mould to
  the body. An ice bag should first be wrapped in
  a towel or cloth to avoid direct contact between
  the skin and the ice. The patient should lie in
  bed with their head resting on the ice bag for 20
  minutes at a time, with the head also supported
  by a pillow.If normal painkillers such as
  paracetamol (e.g. Panadol) do not help, consult
  your GP. Here's an exercise to relieve pain and
  stiffness in the neck and back of the head.
• Stand against a door or a wall with your head
  facing forward and move your eyes so you look
  towards the two, four, eight, and 10 o'clock
  positions. Repeat this a few times. This eye
  movement causes a slight movement in some deep
  muscles in the back of the head.
• Next, take a step forward and perform the
  following movements.
• Bend the back of the head carefully forward as if
  taking a bow. Return to the starting position
  with your head straight and facing forward.
• Draw the chin in towards your neck and bend the
  head carefully forward. Return to the starting
  position. Bend the head backwards far enough to
  look at the ceiling. Return to the starting
  position.
• Tilt the head sideways, so the right ear is near
  the right shoulder. If possible try to maintain
  the glance at a fixed point at eye level. Return
  to the starting position. Repeat this action with
  the head tilted to the other side.
• Turn the head as if trying to look backwards over
  the shoulder, first to the left and then to the
  right. Imagine following a horizontal line on the
  wall at eye level.
• You can also use a beach ball or a soft ball to
  exercise the head and neck muscles. Place the
  ball between the wall and the forehead and then
  try to move it around on the wall in circles or
  figures of eights. Repeat the exercise, this time
  placing the ball between the back of the head and
  the wall.

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How does a doctor diagnose whiplash?

• Usually the diagnosis is made on the basis of the
  background of the injury and the patient's
  description of symptoms. Whiplash cannot be seen
  on an MRI scan, CT scan or X-ray, although an
  X-ray is taken if there is a suspicion of
  fracture or dislocation of the cervical spine.

Exercise
Research has shown that whiplash patients who
rest for several weeks and wear a soft collar
actually recover more slowly than those who try
to follow a normal routine.Patients with acute
pain in the cervical region of the spine are
advised to start their neck exercises as soon as
possible and to get out of bed within two to
three days.
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Outlook

• The risk of sustained after-effects is very
  small and the chances for complete recovery are
  good. However, whiplash is still a strain injury
  and, as with other strain injuries, it is not
  unusual for the pain to last for a couple of
  months.

Whiplash syndrome
A few people develop continuing symptoms
after a whiplash trauma and develop what is known
as whiplash syndrome. They suffer continual
headaches and pain, reduced movement at the back
of the neck, tingling in the arms, lumbar pains,
fatigue, sleep disruptions and reduced libido.
Whiplash syndrome is difficult to treat. The
essence of the treatment is to prevent any
further strain and encourage a quick return to
normal everyday activities.Unfortunately, in a
very small number of people who have experienced
a severe whiplash injury, symptoms can persist
for months or even years before settling and even
then there can even be residual long-term neck
discomfort.
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How is whiplash treated?

• There is no single treatment for whiplash that
  is widely accepted among doctors.If there is no
  suspicion of a fracture or dislocation, the
  patient should begin exercising and pursuing
  normal activities as soon as possible. In some
  cases it may be necessary to supplement an
  exercise programme with painkillers. Further
  advice on exercise and recovery can be sought
  from a physiotherapist or chiropractor. For most
  people the injury will simply pass after a short
  period.

What medication can be used to treat whiplash?

• Paracetamol (eg Panadol) and NSAIDs
  (non-steroidal anti-inflammatory drugs) can be
  given for short periods for pain in the back of
  the neck and headaches. A doctor should be
  consulted first.

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THANK YOU