Severe Bleeding

 Severe bleeding involves loss of large amount of blood 

 This may occur externally through natural openings, like mouth 
 A cut on the skin too can lead to bleeding 
 Internal bleeding occurs due to an injury to blood vessel 

Symptoms

 Discharge of blood from a wound 

 Bruising 
 Blood in stool/urine 
 Blood coming from other areas, like mouth/ear 

   Treatment

 Wash hands well before administering to patient 

 Wear synthetic gloves 
 Make the victim lie down 
 Slightly elevate the legs 
 If possible keep the affected area elevated 
 Remove any obvious debris/particle 
 Apply direct pressure using clean cloth/bandage 
 Use hand if cloth is not available 
 Apply pressure continuously for at least 20 minutes 
 Do not remove the cloth to check the bleeding 
 Hold the bandage in place using an adhesive tape 
 If bleeding seeps through bandage, do not remove it 
 Add extra bandage on top of the first one 
 Apply direct pressure on the artery if necessary 
 The pressure points for arm--below arm- pit/above elbow 
 For leg--behind knee/near groin 
 Squeeze the artery keeping finger flat 
 Continue applying pressure on the wound 
 Once bleeding stops immobilize the affected part 
 See a doctor 

First Aid

1. Have the injured person lie down and

cover the person to prevent loss of body heat. If possible, position the person's head
slightly lower than the trunk or elevate the legs. This position reduces the risk of fainting by
increasing blood flow to the brain. If possible, elevate the site of bleeding.
 2. While wearing gloves, remove any
obvious dirt or debris from the wound. Don't remove any large or more deeply
embedded objects. Don't probe the wound or attempt to clean it at this point. Your principal
concern is to stop the bleeding.
3. Apply pressure directly on the wound
until the bleeding stops. Use a sterile bandage or clean cloth and hold continuous pressure
for at least 20 minutes without looking to see if the bleeding has stopped. Maintain pressure
by binding the wound tightly with a bandage (or a piece of clean cloth) and adhesive tape.
Use your hands if nothing else is available. If possible, wear rubber or latex gloves or use a
clean plastic bag for protection.
4. Don't remove the gauze or bandage. If
the bleeding continues and seeps through the gauze or other material you are holding on the
wound, don't remove it. Instead, add more absorbent material on top of it.
5. Squeeze a main artery if necessary. If
the bleeding doesn't stop with direct pressure, apply pressure to the artery delivering blood
to the area of the wound. Pressure points of the arm are on the inside of the arm just above
the elbow and just below the armpit. Pressure points of the leg are just behind the knee and
in the groin. Squeeze the main artery in these areas against the bone. Keep your fingers flat.
With your other hand, continue to exert pressure on the wound itself.
6. Immobilize the injured body part once
the bleeding has stopped. Leave the bandages in place and get the injured person to the
emergency room as soon as possible.

Appendicitis

Appendicitis is a condition in which the appendix, a small inconsequential appendage to

the colon, becomes inflamed and swollen.

Signs and Symptoms

The pain may begin on the lower right side of the abdomen, but it may also start as a
vague discomfort in the center of the abdomen and then move to the lower right side. Although
not every pain in the abdomen indicates appendicitis, a person should report any pain that
persists and that is accompanied by loss of appetite, nausea, vomiting, and fever to a physician.
Until a doctor determines what is wrong and what should be done, a person should not take
laxatives or enemas.
There are no specific tests for appendicitis, but blood tests (such as a white blood cell
count) and x-rays may help a physician make a diagnosis. Abdominal ultrasound has proven to
be useful in differentiating causes of abdominal pain.
Physicians can perform a laparoscopy by placing a thin telescope-like instrument through a small
incision in the abdomen. This enables a physician to view the abdominal organs directly. If the
cause of pain is appendicitis, the physician will usually remove the appendix immediately.
However, if the appendix is abscessed, the patient may have to take large doses of antibiotics to
reduce infection before the appendix can be removed.
Treatment

The surgery that corrects appendicitis, called an appendectomy, is a procedure with

relatively little risk. Normally, the patient stays in the hospital for less than a week and can
usually count on being back to a normal routine in three weeks. Many surgeons are performing
laparoscopic appendectomy in which the appendix is removed through three small incisions (less
than half an inch long) using special instruments and a special camera. With laparoscopic
appendectomy, most patients can go home within 24 hours of the operation. However, if the
appendix is ruptured, the patient may need to stay in the hospital for a considerably longer period
of time and the risk of complications is much greater. A very ill patient may require special
measures, such as stomach tubes and intravenous medications. If such complications have
occurred, it may be two to three months before the patient can resume normal activity. Once the
useless appendix is removed, there is no danger of appendicitis recurring.

Heart Attack

A heart attack, also known as a myocardial infarction (MI), generally occurs when there
is a blockage of blood flow to the heart, resulting in the heart not recieving the oxygen and
nutrients it needs.

Symptoms of Heart Attack

Warning Signals

The key to surviving a heart attack is promptly recognizing the warning signals and getting
immediate medical attention. If you feel an uncomfortable pressure, fullness, squeezing or pain
in the center of your chest (that may spread to your shoulders, neck or arms) and your discomfort
lasts for two minutes or longer, you could be having a heart attack. Sweating, dizziness, fainting,
nausea, a feeling of severe indigestion, or shortness of breath may also occur, although not all
symptoms do necessarily occur.

When a person has these symptoms, it is natural for him or her to deny what is happening. No
one wants to think that he might be having a heart attack. It is important to know that over
300,000 heart attack victims died before reaching the hospital last year, many of them because
they refused to take their symptoms seriously.

Treatment of Heart Attack

Initial treatment may include nitrates - e.g., sublingual (under the tongue) nitroglycerin, oxygen,
aspirin and pain medication (e.g., morphine).

The objective of thrombolytic (lysing the thrombus) therapy in acute myocardial infarction is to
lyse (dissolve) the coronary thrombus (clot) and allow oxygenated blood to reach the heart
muscle as quickly as possible. The goal is that intervention early in the course of infarction will
limit infarct size, preserve left ventricular function, prevent pump failure and ultimately, prevent
death.

The four thrombolytic agents that have been evaluated extensively in acute infarction are:
streptokinase, tissue plasminogen activator (t-PA), reteplase and anistreplase (APSAC).
Although there is much debate over which agent to use, the overriding consideration is early
adminstration of any one of them.

A number of medical centers now manage acute myocardial infarction with

primary angioplasty of the affected coronary artery. Your physician may suggest other
treatments as well.

Prevention of Heart Attack

Studies in recent years have shown that taking an aspirin every day may reduce the risk of
having a heart attack or a stroke caused by a blood clot forming in an artery. However, it is
important that you first consult your doctor before beginning aspirin therapy.

Some studies have shown that the risk of a heart attack during or just after heavy physical
exertion is two to six times greater than the risk during less strenuous physical activities or no
activity, but regular physical activity diminished the added risk to practically none at all.

Normally sedentary people who try something strenuous like shoveling snow, sprinting to catch
a bus, playing tennis or pushing a car out of a snowdrift, may be especially at risk.

Among the cardiovascular benefits of regular exercise are a diminished tendency of blood to
form clots, an improved cholesterol profile, more efficient use of oxygen by the muscles, a larger
volume of blood pumped with each heartbeat, and during periods of exertion, greater dilation of
the arteries, a lower heart rate and lower blood pressure.

Stroke

A stroke occurs when the arterial blood flow leading to or in the brain becomes blocked or
ruptures.

Blood carries oxygen and nutrients to the neurons (nerve cells) in the brain, so when the blood
flow stops, the cells begin to die. As a result, the functions of the body controlled by the nerve
cells can lose their ability to function.

Symptoms of Stroke

The warning signs of stroke are:

 Sudden weakness or numbness of the face, arm and leg on one side of the body.
  Loss of speech, or trouble talking or understanding speech.
 Dimness or loss of vision, particularly in only one eye.
 Unexplained dizziness, unsteadiness or sudden falls.
 "Temporary strokes" (transient ischemic attacks or TIAs). These can occur days, weeks
or even months before a major stroke. TIAs result when a blood clot temporarily clogs an
artery and part of the brain does not get the supply of blood it needs. The symptoms occur
rapidly and last a relatively short period of time, usually from a few minutes to several
hours. The usual symptoms are like those of a full-fledged stroke, except that the
symptoms of a TIA are temporary, lasting 24 hours or less. In fact, people who have had
TIAs are 9.5 times more likely to have a stroke than people of the same age and sex who
have not had a TIA.

Treatment of Stroke

Treating a stroke depends on where the stroke occurred in your brain and whether it's ischemic
or hemorrhagic. The doctor may use a magnetic resonance imaging (MRI) scan, computed
tomography (CT) imaging or angiography (injecting dye through a catheter inserted into the
suspected blocked blood vessel and taking x-rays of the vessels) to determine the stroke type and
location.

Time is critical. Until a few years ago, strokes were regarded as untreatable. Brain cells were
thought to die within minutes after a stroke began, so stroke treatment was believed useless. The
only onsite medical treatment is stabilization and "wait and see." Now researchers have
discovered that some brain cells die immediately after a stroke, but others can survive for as long
as several days. It is now clear that treatment following a stroke, especially if begun within three
hours of onset, can help preserve brain tissue.

Prevention of Stroke

Strokes may be prevented by lowering your blood pressure, quitting smoking, beginning or
increasing exercise, controlling medical problems with medications (i.e., atrial fibrillation
requires anticoagulants), maintaining optimal weight, and eating a diet high in fruits and
vegetables.

If you have a blocked carotid artery your doctor may suggest a carotid endarterectomy to remove
the fatty deposits.

Convulsions

Convulsions are when a person's body shakes rapidly and uncontrollably. During convulsions,
the person's muscles contract and relax repeatedly.

The term "convulsion" is often used interchangeably with "seizure," although there are many
types of seizures, some of which have subtle or mild symptoms instead of convulsions. Seizures
of all types are caused by disorganized and sudden electrical activity in the brain.
Symptoms:

 Brief blackout followed by period of confusion

 Drooling or frothing at the mouth
 Eye movements
 Grunting and snorting
 Loss of bladder or bowel control
 Sudden falling
 Teeth clenching
 Temporary halt in breathing
 Uncontrollable muscle spasms with twitching and jerking limbs
 Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing
The person may have warning symptoms before the attack, which may consist of:

 Fear or anxiety
 Nausea
 Vertigo
 Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)

Prevention:

People with epilepsy should always take any prescribed medication and wear a medical
alert tag.
Keep fevers under control, especially in children.

First Aid:

1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent
a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other
sharp objects.
2. Cushion the person's head.
3. Loosen tight clothing, especially around the person's neck.
4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit
is not inhaled into the lungs.
5. Look for a medical I.D. bracelet with seizure instructions.
6. Stay with the person until he or she recovers, or until you have professional medical help.
Meanwhile, monitor the person's vital signs (pulse, rate of breathing).
In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid
water. You can give the child acetaminophen (Tylenol) once he or she is awake, especially if the
child has had fever convulsions before. DO NOT immerse the child in a cold bath. See fever
convulsions.

Shock:

Shock is a life-threatening condition that occurs when the body is not getting enough
blood flow. This can damage multiple organs. Shock requires immediate medical treatment and
can get worse very rapidly.

Symptoms:

A person in shock has extremely low blood pressure. Depending on the specific cause and
type of shock, symptoms will include one or more of the following:

 Anxiety or agitation/restlessness
 Bluish lips and fingernails
 Chest pain
 Confusion
 Dizziness, light-headedness, or faintness
 Pale, cool, clammy skin
 Low or no urine output
 Profuse sweating, moist skin
 Rapid but weak pulse
 Shallow breathing
 Unconsciousness

First Aid:

 Call 911 for immediate medical help.

 Check the person's airway, breathing, and circulation. If necessary, begin rescue
breathing and CPR.
 Even if the person is able to breathe on his or her own, continue to check rate of
breathing at least every 5 minutes until help arrives.
 If the person is conscious and does NOT have an injury to the head, leg, neck, or spine,
place the person in the shock position. Lay the person on the back and elevate the legs about
12 inches. Do NOT elevate the head. If raising the legs will cause pain or potential harm,
leave the person lying flat.
 Give appropriate first aid for any wounds, injuries, or illnesses.
 Keep the person warm and comfortable. Loosen tight clothing.
IF THE PERSON VOMITS OR DROOLS

 Turn the head to one side so he or she will not choke. Do this as long as there is no
suspicion of spinal injury.
 If a spinal injury is suspected, "log roll" him or her instead. Keep the person's head, neck,
and back in line, and roll him or her as a unit.

Do Not:

 Do NOT give the person anything by mouth, including anything to eat or drink.
 Do NOT move the person with a known or suspected spinal injury.
 Do NOT wait for milder shock symptoms to worsen before calling for emergency
medical help.

Call immediately for emergency medical assistance if:

Call 911 any time a person has symptoms of shock. Stay with the person and follow the
first aid steps until medical help arrives.

Prevention:

Learn ways to prevent heart disease, falls, injuries, dehydration, and other causes of

shock. If you have a known allergy (for example, to insect bites or stings), carry an epinephrine
pen. Your doctor will teach you how and when to use it.
Once someone is already in shock, the sooner shock is treated, the less damage there may
be to the person's vital organs (such as the kidney, liver, and brain). Early first aid and
emergency medical help can save a life.