heat stroke & heat exhaustion are they same?

DIFFERENCES BETWEEN HEAT EXHAUSTION & HEAT STROKE

Middle east summer months are from June to September .Most of the countries are well prepared to beat high temperatures and humidity. The main victims of heat emergencies are those who work under the sun. Patients numbers will increase during the holy month of Ramadan due to Ramadan fasting. Gulf countries are giving  reduction in duty hours during these days, still ambulance calls steadily increases as the summer progress. 

Heat exhaustion is a heat-related illness that can occur after you've been exposed to high temperatures for long time, often coexist with dehydration.

There are two types of heat exhaustion:

• Water depletion. Signs include excessive thirst, weakness, headache, and loss of consciousness.
• Salt depletion. Signs include nausea and vomiting, muscle cramps, and dizziness.

Although heat exhaustion isn't as serious as heat stroke, but heat exhaustion can progress to heat stroke, which can damage the brain and other vital organs, and even cause death.

Heat stroke is marked hyperthermia  (dramatic increase in body temp 104 F) with loss of conciousness, the body will lost its ability to control its temperature ( failure in thermoregulation). It comes with prolong heat exposure with heavy work.

HEAT STROKE IS A REAL EMERGENCY , IMMEDIATELY CALL FOR 999

SYMPTOMS  HEAT EXHAUSTION \ HEAT STROKE

First Aid

• If you think a person may have heat illness or emergency:Have the person lie down in a cool place. Raise the person's feet .
• Apply cool, wet cloths (or cool water directly) to the person's skin and use a fan to lower body temperature. Place wet towels in neck, groin, and armpits.
• If alert, give the person a beverage to sip (such as a sports drink), or make a salted drink by adding a teaspoon of salt per quart of water. Give a half cup every 15 minutes. Cool water will do if salt beverages are not available.
• For muscle cramps, give beverages as noted above and massage affected muscles gently, but firmly, until they relax.
• Call 999 and give first aid as needed.

We can prevent heat illness by..

1. Wear loose-fitting, lightweight and light-colored clothing in hot weather.
2. Rest often and seek shade when possible.
3. Avoid exercise or heavy physical activity outdoors during hot or humid weather.
4. Drink plenty of fluids every day. Drink more fluids before, during, and after physical activity.
5. Be very careful to avoid overheating if you are taking drugs that impair heat regulation, or if you are overweight or elderly.
6. Be careful of hot cars in the summer. Allow the car to cool off before getting in.
7. Never leave a child sitting in a car exposed to the hot sun, even after opening windows.

For safer beach holidays...

JELLYFISH STINGS

Most jellyfish stings are mild and don't require treatment, or you can treat them yourself.However, dial 999 if there are severe symptoms, such as difficulty breathing or chest pain, or if a large or sensitive area of the body such as the face or genitals has been stung.

Someone stung by a jellyfish should be treated out of the water.

Any remaining tentacles should be removed using tweezers or a clean stick (wear gloves if they're available). Applying an ice pack to the affected area helps to reduce pain and inflammation.

Vinegar is no longer recommended for treating jellyfish stings, because it may make things worse, by activating unfired stinging cells. The use of other substances, such as alcohol and baking soda, should also be avoided.

Ignore any advice you may have heard about urinating on the sting. It's unlikely to help and may make the situation worse.

Use a razor blade, credit card or shell to remove any nematocysts (small poisonous sacs) that are stuck to the skin. It may help to apply a small amount of shaving cream to the affected area first.

AFTERCARE

After a jellyfish sting, any pain and swelling can be treated with painkillers.

SYPHILIS

SYPHILIS

Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex. Occasionally, the disease can be passed to another person through prolonged kissing or close bodily contact. Although this disease is spread from sores, the vast majority of those sores go unrecognized. The infected person is often unaware of the disease and unknowingly passes it on to his or her sexual partner.

After the initial infection, the syphilis bacteria can lie dormant in your body for decades before becoming active again. Early syphilis can be cured, sometimes with a single injection of penicillin. Without treatment, syphilis can severely damage your heart, brain or other organs, and can be life-threatening.

Pregnant women with the disease can spread it to their baby. This disease, called congenital syphilis, can cause abnormalities or even death to the child.

Syphilis cannot be spread by toilet seats, door knobs, swimming pools, hot tubs, bath tubs, shared clothing, or eating utensils.

FLY FREELY, PREVENTION OF JET LAG

JET LAG

Jet lag is also known as time zone change syndrome or desynchronosis. Jet lag can occur when people travel rapidly from east to west, or west to east on a jet plane. It is a physiological condition which upsets our body's circadian rhythms - hence, it is classified as a circadian rhythm disorder. Jet lag symptoms tend to be more severe when the person travels from westward compared to eastward.

SYMPTOMS 

1.  fatigue and insomnia 
2.  anxiety 
3. constipation
4. diarrhea
5. confusion 
6. dehydration
7.  headache
8.  irritability
9. nausea
10. sweating
11. coordination problems
12.  dizziness
13. even memory loss
14.  heartbeat irregularities 
15.  increased susceptibility to illness.

PREVENTION

 Change your schedule 

If your stay in the destination time zone will last more than a few days, begin adjusting your body to the new time zone before you leave. For example, if you are traveling from the U.S. to Europe for a one-month vacation, set your daily routine back an hour or more three to four weeks before departure. Then, set it back another hour the following week and the week after that. Easing into the new schedule gradually in familiar surroundings will save your body the shock of adjusting all at once.

If you are traveling east, try going to sleep earlier and getting up and out into the early morning sun. If traveling west, try to get at least an hour's worth of sunlight as soon as possible after reaching your destination.

Avoid alcohol 

Do not drink alcoholic beverages the day before your flight, during your flight, or the day after your flight. These beverages can cause dehydration, disrupt sleeping schedules, and trigger nausea and general discomfort.

 Avoid caffeine 

Likewise, do not drink caffeinated beverages before, during, or just after the flight. Caffeine can also cause dehydration and disrupt sleeping schedules. What's more, caffeine can jangle your nerves and intensify any travel anxiety you may already be feeling.

Drink water

Drink plenty of water, especially during the flight, to counteract the effects of the dry atmosphere inside the plane. Take your own water aboard the airplane if allowed.

Move around on the planE

While seated during your flight, exercise your legs from time to time. Move them up and down and back and forth. Bend your knees. Stand up and sit down. Every hour or two, get up and walk around. Do not take sleeping pills, and do not nap for more than an hour at a time.

Break up your trip

On long flights traveling across eight, 10, or even 12 time zones, break up your trip, if feasible, with a stay in a city about halfway to your destination. For example, if you are traveling from New York to Bombay, India, schedule a stopover of a few days in Dublin or Paris. (At noon in New York, it is 5 p.m. in Dublin, 6 p.m. in Paris, and 10:30 p.m. in Bombay.)

Wear comfortable shoes and clothes 

On a long trip, how you feel is more important than how you look. Wear comfortable clothes and shoes. Avoid items that pinch, restrict, or chafe. When selecting your trip outfit, keep in mind the climate in your destination time zone. Dress for your destination.

DIET 

When it comes to air travel, there are some well-known diet maxims: avoid excess alcohol or caffeine, drink plenty of water, and eat light meals.

But Dr. Charles F. Ehret, a scientist at the Argonne National Laboratory in Illinois, says that it's possible to use diet to help reset your body's clock to a new time zone. Called the "Argonne diet" or the "anti-jet lag diet", the diet was developed after research with experimental animals and humans.

Basically, the diet alternates feast and fast days and ends with a high-protein breakfast:

Begin three days prior to departure.

Day 1: Feast day

Eat predominantly high-protein foods (e.g. meat, fish, chicken, cheese, eggs, tofu) for breakfast and lunch. The theory is that these foods stimulate the body's production of epinephrine, norepinephrine, and dopamine (substances called catecholamines) which help the body maintain an alert, awake state.

Dinner should be carbohydrates (e.g. cereal grains, wheat, rice, oats, potatoes, fruit, peas, pasta, bread, dried fruit) with no high-protein foods. Carbohydrate-rich foods are believed to stimulate the body to produce melatonin.

Coffee, tea, and caffeinated sodas are only permitted between 3 and 5 pm during the first three days, a time of day when caffeine is not thought to affect circadian rhythms.

Day 2: Fast day

Only light meals such as salads and thin soups are recommended. These so-called "fast" days are thought to deplete the liver's store of glycogen (a muscle fuel) to prepare the body to reset its clock.

Day 3: Feast day

Follow the same guidelines as day 1.

Day 4 (departure day): Fast day

Follow the modified fast and get as much sleep as you can until it is breakfast time at your destination. If traveling westward, caffeine is permitted in the morning of the departure, and if traveling eastward, caffeine is permitted between 6 and 11 pm.

When your watch indicates that it is breakfast time at your destination, have a protein-heavy breakfast without coffee, turn on the overhead reading light and then stay as active as you can afterwards. If you are traveling from New York to Paris and departed at 7:00 pm, this means having breakfast at 2:00 am New York time (8:00 am Paris time). The flight attendant may agree to save your dinner until that time or you can pack food such as protein bars with you.

Eat the rest of the meals according to normal mealtimes at your destination.

CHOKING IN BABIES

                         

FIRST AID MANAGEMENT FOR CHOKING

Choking is a common cause of injury and death in young children, primarily because their small airways are easily obstructed. It takes time for babies to master the ability to chew and swallow food, and babies might not be able to cough forcefully enough to dislodge an airway obstruction. As babies explore their environments, they also commonly put objects into their mouths which can easily lead to infant choking.

PREVENTION OF CHOKING

• Cut food in to bite sized pieces
• Cook or smash hard foods
• Always check baby's mouth
• Always give steamed vegetables
• Maintain high chair position
• Do not feed while baby cries or laughing
• Always careful  about grapes,peanuts and pop corns
• Always put coins in a closed container.

      

Step 1: Assess the situation quickly.

If a baby is suddenly unable to cry or cough, something is probably blocking her airway, and you'll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.

If she's coughing or gagging, it means her airway is only partially blocked. If that's the case, let her continue to cough. Coughing is the most effective way to dislodge a blockage.

If the baby isn't able to cough up the object, ask someone to call  the local emergency number while you begin back blows and chest thrusts .

If you're alone with the baby, give two minutes of care, then call ambulance.

Step 2: Try to dislodge the object with back blows and chest thrusts. 

First do back blows

If a baby is conscious but can't cough, cry, or breathe and you believe something is trapped in his airway, carefully position him faceup on one forearm, cradling the back of his head with that hand.

Place the other hand and forearm on his front. He is now sandwiched between your forearms.

Use your thumb and fingers to hold his jaw and turn him over so that he's facedown along the other forearm. Lower your arm onto your thigh so that the baby's head is lower than his chest.

Using the heel of your hand, deliver five firm and distinct back blows between the baby's shoulder blades to try to dislodge the object. Maintain support of his head and neck by firmly holding his jaw between your thumb and forefinger.

Next, place your free hand (the one that had been delivering the back blows) on the back of the baby's head with your arm along his spine. Carefully turn him over while keeping your other hand and forearm on his front.

Then do chest thrusts

Use your thumb and fingers to hold his jaw while sandwiching him between your forearms to support his head and neck. Lower your arm that is supporting his back onto your opposite thigh, still keeping the baby's head lower than the rest of his body

Place the pads of two or three fingers in the center of the baby's chest, just below an imaginary line running between his nipples. 

To do a chest thrust, push straight down on the chest about 1 1/2 inches. Then allow the chest to come back to its normal position.

Do five chest thrusts. Keep your fingers in contact with the baby's breastbone. The chest thrusts should be smooth, not jerky.

Repeat back blows and chest thrusts

Continue alternating five back blows and five chest thrusts until the object is forced out or the baby starts to cough forcefully, cry, or breathe on his own. If he's coughing, let him try to cough up the object.

If the baby becomes unconscious

If a baby who is choking on something becomes unconscious, you'll need to do what's called modified CPR. Here's how to do modified CPR on a baby:

Open his mouth and look for an object. If you can see an object, remove it with your little finger.

Give him two rescue breaths. If the air doesn't go in (you don't see his chest rise), tilt his head and try two rescue breaths again.

If his chest still doesn't rise, do 30 chest compressions.

Look in his mouth and remove the object if you see it. Give him two more rescue breaths.

Repeat the chest compressions and so on, until help arrives.

what's the difference between pulmonary oedema and a pleural effusion?

what's the difference between pulmonary oedema and a pleural effusion?

Pleural Effusions
--------------------
First things first. The pleural is a 2 layered membrane that surrounds the lungs. Pleural effusion is fluid in this space. This can be either exudative or transudative. Causes for this phenomenon include: Cancer, High BP, TB, pneumonia, trauma, PE, SLE etc

SIGNS AND SYMPTOMS
Pleural effusions often cause no symptoms. Symptoms are more likely when a pleural effusion is moderate or large-sized, or if inflammation is present. Symptoms of pleural effusions may include:

Shortness of breath
Chest pain, especially on breathing in deeply (pleurisy, or pleuritic pain)
Fever
Cough
Because pleural effusions are usually caused by underlying medical conditions, symptoms of these conditions are also often present.

Pulmonary Oedema
-----------------------
Pulmonary oedema occurs when the alveolar beds get engorged in the lungs. As compared to pleural effusion, where there is a nice pool of fluid pushing on your lung tissue, this time around, you have fluid IN your lung tissue. All over it. Diffusely. Well, mainly in the lower lobes though due to gravity.

SIGNS & SYMPTOMS
peripheral edema
difficulty breathing, but may also include coughing up blood (classically seen as pink, frothy sputum),
excessive sweating,
anxiety, and pale skin.
Shortness of breath can manifest as orthopnea

INTUBATION MEDICATIONS

INTUBATION MEDICATIONS 

Specific Agents 

Sedatives-Hypnotics: rapid onset of unconsciousness (0.5 to 1 minute) and short duration of action

Thiopentone sodium (Pentothal)
• a barbiturate
• 2-5 mg/kg
• increased venous capacitance _ decreased preload___CO and _BP
• Hypovolemic patients and those with poor cardiac reserve are prone to hypotension with induction
• Increased HR
• Useful as induction agent and brief sedation
• Respiratory depression can be significant

Propofol (Diprivan)
• an isopropyl phenol
• 1-2.5mg/kg
• more rapid and complete awakening compared to barbiturates
• reduces blood pressure more than thiopental
• exaggerated hemodynamic effects in hypovolemic patients
• pain with injection into non-antecubital, small vein

Antianxiety agents
Amnestic, anticonvulsant, hypnotic, and sedative effects. Useful sedation for procedures and toleration of mechanical ventilation.

Benzodiazepines

Midazolam
• sedation: 0.5-1 mg increments
• induction: 0.15-0.35 mg/kg
• amnestic: 50 mcg/kg
• mild vasodilatation
• respiratory depression: increased in the elderly and when combined with narcotics
• onset 1 - 2 mins. and recovery 30 - 120 mins.

Diazepam
• sedation: 2 - 10mg (adults)
• onset 1 -2 mins. and recovery 2 - 4 hrs.
Muscle relaxants
FULL VENTILATORY SUPPORT IS MANDATORY

Suxamethonium chloride
• depolarising muscle relaxant
• indications: facilitate tracheal intubation, provide skeletal muscle relaxation during surgery or mechanical ventilation
• intubation: 0.5-1.5 mg/kg
• onset: 60 seconds
• recovery time: 3-10 minutes
• Cardiac dysrhythmia including sinus bradycardia, junctional rhythm, and sinus arrest have been reported. May cause tachycardia in adults and bradycardia in children
• significant hyperkalemia may result in patients with skeletal muscle myopathy, neurologic deficits, prolonged bed rest, multiple trauma, major burns (safe within first 24 hours of burn)
• risk of hyperkalemia peaks at 7-10 days post burn, neurologic injury or multiple trauma
• Use in children should be reserved for emergency intubation or instances where immediate securing of the airway is necessary.
• Increases intraocular, intragastric and intracranial pressure

Vecuronium bromide (Norcuron)
• steroidal analogue of pancuronium
• intubation: 0.08-1 mg/kg
• onset: ~ 3 minutes
• duration: 20-35 minutes
• hemodynamically benign

Pancuronium bromide
• Intubation: 0.1 mg/kg
• onset: 3-5 minutes
• duration: 60-90 minutes
• 10-15% increase in HR, arterial BP and CO

Local Anesthetics

Lignocaine Spray (Xylocaine Spray)
• goals: topical anaesthesia to increase patient comfort, control hemodynamics and facilitate tracheal intubation via oral or nasal routes.
• Amide local anaesthetic, metabolized by the liver.
• elective nasotracheal intubation: 3-5 cc of 2% lidocaine in an atomiser inhaled into each nares or 4 cc of 4% lidocaine nebulised into the oropharynx; both techniques completely anaesthetise the vocal cords in ~ 5 minutes
• Intravenous route may be effective in blunting the response to laryngoscopy and intubation