Dealing with unconscious victims

By

The Ministry of Health

An unconscious victim is defined as a person who is unresponsive to verbal commands and stimulus. An unconscious victim may or may not have breathing and signs of circulation (breathing, coughing and movements).

The first priority is to open the airway to get air into the lungs so that oxygen can reach the brain and other vital organs. Remember, brain damage begins within four to six minutes if nothing is done.

Some injuries and illnesses can result in a victim becoming confused or even unconscious. The individual may be wide awake and alert, completely unresponsive to outside stimulation or somewhere between these extremes.

Causes: May vary, that include: Severe bleeding, severe burns, epilepsy, heart attack, stroke, diabetes, hypertension and so on.

Initial assessment should be made thoroughly and quickly. The purposes are mainly to prioritise the victim, find the main causes of such condition and to determine the existence of life threatening conditions.

If the victim is not fully conscious, you need to monitor any changes in the level of response as the victim's condition can deteriorate and he may become unconscious at any time.

NOTE: In any case, if the victim is not responding to any means of stimuli, further assessment needs to be carried out. (Please refer to CPR procedures)

Safety measure should be made when handling an unconscious victim as you do not want the victim to suffer any wrongdoings being done on him.
Below are some steps that need to be taken into account when you attempt to rescue the victim.

DO:
- Activate Emergency Medical Ambulance Service (EMAS 991),
- Check any danger to you or the victim as you approach the scene,
- Look for clues such as special bracelet or necklace that may indicate the victim has any illnesses such as diabetes mellitus or epilepsy,
- Make sure that the victim's airway is opened; any loose dentures need to be removed;
- Check the victim for any obvious injuries eg bleeding, fracture or evidence of falling from a certain height and so on,
- Put the victim in the recovery position; if trauma is not suspected and victim is breathing or resumes breathing and signs of circulation,
- Observe the victim's condition every three to five minutes, while waiting for the ambulance to arrive,
- Loosen tight clothing especially around the neck, chest and waist,
- Move the victim (if there is no suspected head or neck injury) to open air if victim is in a crowded place,
- Raise and support the legs to improve the blood supply to the vital organs, unless there are obvious injuries to the victim's body,
- Cover the victim with a blanket or whatever else is available to conserve heat.

DON'T:
- Leave the victim alone unless you have to go for help,
- Delay the victim's removal to the hospital,
- Remove the victim if you suspect the victim has a head or spine injury,
- Let the victim eat, drink or smoke,
- Throw any water over the victim's face and/or body,
- Slap the victim's face,
- Shout, scream or shake the victim,
- Give any medications, hot drinks or any alcoholic beverages,
- Use smelling salts or ammonia inhalants.

PRECAUTION
- If you suspect the victim is having head or spinal injury, try to leave the victim in the position in which you found him/her.
- If you need to put the victim in the recovery position, keep the victim's - head and neck in alignment with the body.

Source: Weekend, 28 Feb 2009

Skin disease and your work

By

Ministry of Health

What is occupational skin disease or dermatosis?
Occupational skin disease or dermatosis is skin disease due to workplace exposures to physical, chemical or biological agents.

What is the most common type of occupational dermatosis?
The most common type is contact dermatitis. Dermatitis or eczema is inflammation of the skin which is characterised by redness, swelling, fluid-filled blisters and oozing in acute stages and thickening, broken skin and colour changes in the chronic stage of the disease.

What are the different types of contact dermatitis found in the workplace?
There are two major types of dermatitis: irritant contact dermatitis caused by irritants, and allergic contact dermatitis caused by allergens

A previous medical history of a skin diseas, such as eczema, the pre-existing disease may aggravate these irritants/allergens.

What are the high risk occupations which can cause contact dermatitis?

An example of such high risk jobs and the cause of the skin disease:


What are the other common types of occupational dermatosis?

- Heat rash due to excessive heat
- Sun-damaged skin due to prolonged exposure to ultraviolet light
- Fungal infection
- Parasites such as mites
- Acne-caused by oil and grease
- Skin cancer caused by ultraviolet light, pitch and tar


How can we prevent occupational dermatosis?
- Always follow proper and safe work practices
- Always practise good personal hygiene
- Ensure adequate environmental conditions, such as proper ventilation and temperature
- Do not use solvents or abrasive detergents to clean your skin. Use proper skin cleansers or a mild soap. If possible, take a shower before going home
- Use barrier creams if appropriate and regular moisturisers
- Dry your skin thoroughly after work. Ensure disposable towels are provided to dry your hands
- Use personal protective equipment such as masks, boots, gowns and hypoallergenic gloves if appropriate to avoid skin contamination.

Ministry of Health Public Awareness Programme

Source: Weekend 14 Feb 2009

Self-management of Osteo-Arthritic knee

By

Mohammad Khairul Anuar Bin Pehin Haji Hasrin,

Physiotherapy Dept, RIPAS Hospital

Osteo-arthritis is a wear and tear process occurring in joints in the body that are under the most stress eg the knee, hip, lower back and neck. Many people are affected by this condition although it is mainly the middle-aged or elderly who is affected, younger people, as early as thirty can show mild arthritic symptoms.

ANATOMY
The knee joint is made up of two bones of the thigh and lower leg - the femur and tibia. They have a smooth polished surface at their end called cartilage. The cartilage allows free gliding movement between the two bones. It also acts as a shock absorber. A strong bag-like membrane called the capsule surrounds the whole joint. It is reinforced by ligaments, which bind the joint together. Inside the capsule is the joint fluid (synovium). The joint fluid is important in lubricating the joint and nourishing the cartilage. Each of these structures is involved in the wear and tear process of osteo-arthritis.

PATHOLOGY
In osteo-arthritis of the knee, the cartilage becomes roughened and begins to thin out in the part of the joint where usually more weight is borne or sometimes where no movement occurs - eventually patches of bone are exposed. The exact initiating factor is still uncertain, but the condition will be aggravated by a combination and variety of factors, which include the durability of cartilage, the natural ageing process, over use or lack of use, a previous injury and excess weight.

RESULTS
The surrounding capsule and ligaments respond to these changes by a stiffening process. The effects are felt after a period of inactivity. The stiffening loosens up with movement. As the joint surfaces become closer and less smooth, movement becomes less supple. Reduced shock absorption makes the knee more vulnerable to stress, so that aching follows any stress more readily.

ACTION NEEDED
Once the cartilage has worn away, it cannot be replaced, therefore you should aim to conserve your cartilage. This can be done by reducing stress to the cartilage and keeping the cartilage well nourished, which it receives from the joint fluid. These nutrients have to be squeezed into the cartilage by the pressure of movement, otherwise the cartilage starves. Thus the nutrients have to be pumped into the area by muscular movement and then squeezed into the cartilage.

DO's AND DON'Ts

Joint Mobility
Don't be immobile - Long periods of immobility should be avoided as it means there is no squeezing effect of the joint fluid into the cartilage.
Do be mobile - Keep your knee movement full. Allowing your knees to stiffen and lose some movement at extreme straight or bent positions will restrict your activities and reduce nourishment to the cartilage.

Compression Of The Joint
Don't compress your joints excessively - For example, long bouts of standing, walking or running; sudden impact on your joint (running on concrete, stepping awkwardly down steps); being overweight or carrying extra weight (shopping or carrying young children for too long) Also try to be and maintain your optimum weight.

Do ease off weight on joint regularly - Keep shifting from one foot to the other; sit down to take weight off your feet whenever possible; use a walking stick to help reduce the weight going through the joint.

Do compensate for the loss of shock - Step carefully down steps; wear correct footwear with good shock absorbing soles (eg crepe or sorbo-rubber); when kneeling, use a foam cushion.

Twisting The Joint
Don't twist the joint - This stressful movement eg. getting up from the floor, will grind the joint surfaces together and strain the ligaments and capsule.

Do avoid twisting the joint - Avoid having to get up from the floor or sitting back on your heels; wear low heel shoes; sit with your leg uncrossed.

Strength Of Surrounding Muscles
Don't let leg muscles weaken - If this happens, the support of the knee joint is reduced, and your knee will be more vulnerable to strain.

Do protect your joint by keeping muscles strong by exercising them.

PRACTICAL TIPS AT HOME TO HELP EASE YOUR ACHES AND PAINS
Wear knee supports or bandages - Their warmth and gentle pressure may help to ease your symptoms.
Massage around your knee - Gentle but firm circular kneading movements with the pads of your fingers may help ease the symptoms of stiffness around your joint.
Heat applied to the joint - This can help reduce the sensation of pain experienced. Use a quarter filled hot water bottle, filled with 'bath hot' water. Apply to your knee and leave for 15-20 minutes, this should feel very comfortable.
Cold may be more effective for some people, especially if heat tends to make no difference. Crush ice cubes in a dampened face flannel and apply to your knee. Allow approximately 10-15 minutes. Your knee should be slightly pink at the end.

Ministry of Health Public Awareness Programme

(Ref: A Practical Guide To The Care And Protection Of The Osteo-Arthritic Knee - Written By Chartered Physiotherapists, United Kingdom)

Source: Weekend 7 Feb 2009